Provider Demographics
NPI:1972054419
Name:JOHNSON, CHERYL
Entity type:Individual
Prefix:MS
First Name:CHERYL
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 1:231 W HORIZON RIDGE PKWY APT 1212
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-5423
Mailing Address - Country:US
Mailing Address - Phone:702-860-9961
Mailing Address - Fax:
Practice Address - Street 1:231 W HORIZON RIDGE PKWY APT 1212
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-5423
Practice Address - Country:US
Practice Address - Phone:702-860-9961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst