Provider Demographics
NPI:1386299923
Name:TREDOUX, JOHAN (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHAN
Middle Name:
Last Name:TREDOUX
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24712 W 91ST TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66227-4306
Mailing Address - Country:US
Mailing Address - Phone:913-620-3256
Mailing Address - Fax:
Practice Address - Street 1:24712 W 91ST TER
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66227-4306
Practice Address - Country:US
Practice Address - Phone:913-620-3256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral