Provider Demographics
NPI:1952796930
Name:GRANT JOHNSON
Entity Type:Organization
Organization Name:GRANT JOHNSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:405-596-2369
Mailing Address - Street 1:215 NE 28TH ST
Mailing Address - Street 2:#2411
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-2840
Mailing Address - Country:US
Mailing Address - Phone:405-596-2369
Mailing Address - Fax:
Practice Address - Street 1:215 NE 28TH ST
Practice Address - Street 2:#2411
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-2840
Practice Address - Country:US
Practice Address - Phone:405-596-2369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health