Provider Demographics
NPI:1699068486
Name:JOHNSON, SHAUNA (LCSW)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 61 BOX 101
Mailing Address - Street 2:
Mailing Address - City:HIKO
Mailing Address - State:NV
Mailing Address - Zip Code:89017-9630
Mailing Address - Country:US
Mailing Address - Phone:702-556-2251
Mailing Address - Fax:775-726-3299
Practice Address - Street 1:4455 ALLEN LN STE 130
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2208
Practice Address - Country:US
Practice Address - Phone:702-385-1072
Practice Address - Fax:702-385-3053
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6061-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical