Provider Demographics
NPI:1982076105
Name:JOHNSON, CHRISTEN CUILLIER
Entity Type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:CUILLIER
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10936 OLD HAMMOND HWY # 41263
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-8313
Mailing Address - Country:US
Mailing Address - Phone:225-755-9168
Mailing Address - Fax:
Practice Address - Street 1:10936 OLD HAMMOND HWY # 41263
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8313
Practice Address - Country:US
Practice Address - Phone:225-755-9168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600964601Medicaid