Provider Demographics
NPI:1811484561
Name:JOHNSON, EARL JR (MPA)
Entity type:Individual
Prefix:MR
First Name:EARL
Middle Name:
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16332 NATALIE LN
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-5378
Mailing Address - Country:US
Mailing Address - Phone:225-773-3999
Mailing Address - Fax:225-410-3599
Practice Address - Street 1:16332 NATALIE LN
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-5378
Practice Address - Country:US
Practice Address - Phone:225-773-3999
Practice Address - Fax:225-410-3599
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty