Provider Demographics
NPI:1902266521
Name:JOHNSON, AUDRIE PAYTON (LMSW; MSW U/S)
Entity Type:Individual
Prefix:MRS
First Name:AUDRIE
Middle Name:PAYTON
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW; MSW U/S
Other - Prefix:MS
Other - First Name:AUDRIE
Other - Middle Name:PAYTON
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2310 W BROADWAY ST.
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401
Mailing Address - Country:US
Mailing Address - Phone:918-682-7210
Mailing Address - Fax:918-463-2585
Practice Address - Street 1:1002 CAMBELL ST.
Practice Address - Street 2:
Practice Address - City:WARNER
Practice Address - State:OK
Practice Address - Zip Code:74469
Practice Address - Country:US
Practice Address - Phone:918-682-7210
Practice Address - Fax:918-463-2585
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK8628104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator