Doctor Name: | MRS. LUSITA M JOHNSON |
NPI Number: | 1063603215 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | BA |
License Number: | |
Business Practice Address: | 167 N Main St Tuba City, AZ - 860450600 |
Business Phone Number: | 9282832831 |
Business Fax Number: | 9282832832 |
Mailing Address: | 167 N Main St, Po Box 600 TUBA CITY |
State: | AZ |
Postal Code: | 860450600 |
Phone Number: | 9282832831 |
Fax Number: | 9282832832 |
NPI Enumeration Date: | 08/05/2007 |
NPI Last Update Date: | 08/05/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |