| Doctor Name: | MRS. SHELLEY KAY JOHNSON |
| NPI Number: | 1073859047 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | W081093352 |
| Business Practice Address: | 801 E Main St Tishomingo, OK - 734602351 |
| Business Phone Number: | 5803712369 |
| Business Fax Number: | |
| Mailing Address: | 801 E Main St, TISHOMINGO |
| State: | OK |
| Postal Code: | 734602351 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 12/19/2012 |
| NPI Last Update Date: | 12/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TR0400X |
| License Number: | W081093352 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Rehabilitation |
| Taxonomy Definition: | |