Provider Demographics
NPI:1902263403
Name:JOHNSON, MARTISHA
Entity Type:Individual
Prefix:
First Name:MARTISHA
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 1:90 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5926
Mailing Address - Country:US
Mailing Address - Phone:318-238-3197
Mailing Address - Fax:318-238-3199
Practice Address - Street 1:90 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5926
Practice Address - Country:US
Practice Address - Phone:318-238-3197
Practice Address - Fax:318-238-3199
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health