Provider Demographics
NPI:1386029122
Name:JOHNSON, AMSALU HAROLD SR
Entity type:Individual
Prefix:MR
First Name:AMSALU
Middle Name:HAROLD
Last Name:JOHNSON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:PROF
Other - First Name:AMSALU
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1350 GRAN SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-2563
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1350 GRAND SUMMIT DR
Practice Address - Street 2:APT 316
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-2586
Practice Address - Country:US
Practice Address - Phone:775-217-1473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health