Provider Demographics
NPI:1992365373
Name:JOHNSON, EMILY ANN (RBT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10609 S JOPLIN AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-7118
Mailing Address - Country:US
Mailing Address - Phone:918-605-3484
Mailing Address - Fax:
Practice Address - Street 1:7170 S BRADEN AVE STE 195
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6324
Practice Address - Country:US
Practice Address - Phone:918-280-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT-19-89979106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician