Provider Demographics
NPI:1831826833
Name:JOHNSON, KESHON LORENZO
Entity type:Individual
Prefix:MR
First Name:KESHON
Middle Name:LORENZO
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 N PEACH AVE APT 143
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-8502
Mailing Address - Country:US
Mailing Address - Phone:415-424-2190
Mailing Address - Fax:
Practice Address - Street 1:1491 N PEACH AVE APT 143
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-8502
Practice Address - Country:US
Practice Address - Phone:415-424-2190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)