Provider Demographics
NPI:1386469104
Name:JOHNSON, AYSIA LASHUN (MS, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:AYSIA
Middle Name:LASHUN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:AYSIA
Other - Middle Name:LASHUN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, BCBA, LBA
Mailing Address - Street 1:4751 LANDS END DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-7438
Mailing Address - Country:US
Mailing Address - Phone:901-232-4984
Mailing Address - Fax:
Practice Address - Street 1:753 JEFFERSON AVE APT 213
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-5050
Practice Address - Country:US
Practice Address - Phone:901-232-4984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1664103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst