Provider Demographics
NPI:1750515177
Name:JOHNSON, DELSA A (LPC CANDIDATE)
Entity type:Individual
Prefix:
First Name:DELSA
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5613 S QUINCY PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-7918
Mailing Address - Country:US
Mailing Address - Phone:918-510-5844
Mailing Address - Fax:
Practice Address - Street 1:5613 S QUINCY PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-7918
Practice Address - Country:US
Practice Address - Phone:918-510-5844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)