Provider Demographics
NPI:1942900055
Name:JOHNSON, RANDI (MHP)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 GROVE BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-2171
Mailing Address - Country:US
Mailing Address - Phone:317-717-4478
Mailing Address - Fax:
Practice Address - Street 1:4343 SUN N LAKE BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2162
Practice Address - Country:US
Practice Address - Phone:863-414-7442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health