Provider Demographics
NPI:1982138640
Name:JOHNSON, GARYEL
Entity Type:Individual
Prefix:
First Name:GARYEL
Middle Name:
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 1:2350 PARK PLACE DR
Mailing Address - Street 2:68
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-3059
Mailing Address - Country:US
Mailing Address - Phone:504-316-5845
Mailing Address - Fax:
Practice Address - Street 1:2350 PARK PLACE DR
Practice Address - Street 2:68
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-3059
Practice Address - Country:US
Practice Address - Phone:504-316-5845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health