Provider Demographics
NPI:1386917334
Name:JOHNSON, PAULA
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 S JONES BLVD STE 100A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5625
Mailing Address - Country:US
Mailing Address - Phone:702-820-3061
Mailing Address - Fax:702-935-0008
Practice Address - Street 1:2780 S JONES BLVD STE 100A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5625
Practice Address - Country:US
Practice Address - Phone:702-820-3061
Practice Address - Fax:702-935-0008
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP0263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health