Provider Demographics
NPI:1134631161
Name:JOHNSON, CHRISTINE (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BUTTERCUP CV
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-6106
Mailing Address - Country:US
Mailing Address - Phone:925-639-0419
Mailing Address - Fax:800-385-8191
Practice Address - Street 1:110 BUTTERCUP CV
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-6106
Practice Address - Country:US
Practice Address - Phone:925-639-0419
Practice Address - Fax:800-385-8191
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-17-26632103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ075190Medicaid