Provider Demographics
NPI:1972531812
Name:JOHNSON, STEPHEN MATTHEW (MHPP)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MATTHEW
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6430
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72766-6430
Mailing Address - Country:US
Mailing Address - Phone:479-750-2020
Mailing Address - Fax:870-423-3199
Practice Address - Street 1:208 HIGHWAY 62 W
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-8872
Practice Address - Country:US
Practice Address - Phone:479-750-2020
Practice Address - Fax:870-423-3199
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS