Provider Demographics
NPI:1114736865
Name:JOHNSON, OMARIAH-MONICK JANAI
Entity type:Individual
Prefix:
First Name:OMARIAH-MONICK
Middle Name:JANAI
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 1:2117 SHADOW MOUNTAIN PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-3191
Mailing Address - Country:US
Mailing Address - Phone:951-421-6042
Mailing Address - Fax:
Practice Address - Street 1:2117 SHADOW MOUNTAIN PL
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-3191
Practice Address - Country:US
Practice Address - Phone:951-421-6042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service