Provider Demographics
NPI:1225198179
Name:JOHNSON, THOMAS M (BACHELORS DEGREE)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:BACHELORS DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 NO 60TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104
Mailing Address - Country:US
Mailing Address - Phone:402-554-0520
Mailing Address - Fax:501-551-8797
Practice Address - Street 1:3020 18TH ST
Practice Address - Street 2:STE 17
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601
Practice Address - Country:US
Practice Address - Phone:402-563-3833
Practice Address - Fax:402-562-8714
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker