Provider Demographics
NPI:1184979312
Name:PHILLIPS, JOHNNA M (BS, MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:JOHNNA
Middle Name:M
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:BS, MS, LPC
Other - Prefix:MRS
Other - First Name:JOHNNA
Other - Middle Name:N
Other - Last Name:MITCHELLPHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, MS, LPC
Mailing Address - Street 1:229 DEERHURST DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-3875
Mailing Address - Country:US
Mailing Address - Phone:405-651-8418
Mailing Address - Fax:
Practice Address - Street 1:909 ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5229
Practice Address - Country:US
Practice Address - Phone:405-573-3953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health