Provider Demographics
NPI:1386481802
Name:JOHNSON, TAMARA (BCBA)
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7507 VIRTUOSO PASS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78266-2944
Mailing Address - Country:US
Mailing Address - Phone:210-702-1611
Mailing Address - Fax:
Practice Address - Street 1:4470 GREEN VALLEY RD STE 129
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-3064
Practice Address - Country:US
Practice Address - Phone:210-767-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst