Provider Demographics
NPI:1962772566
Name:JOHNSON, RENETTA LYNN (BHRS)
Entity type:Individual
Prefix:MRS
First Name:RENETTA
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 N MIDWEST BLVD
Mailing Address - Street 2:APT. 1
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-6203
Mailing Address - Country:US
Mailing Address - Phone:405-248-1270
Mailing Address - Fax:
Practice Address - Street 1:1525 N MIDWEST BLVD
Practice Address - Street 2:APT. 1
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-6203
Practice Address - Country:US
Practice Address - Phone:405-248-1270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health