Provider Demographics
NPI:1710227897
Name:JOHNSON, ANGEL BREAIL (BHRS)
Entity type:Individual
Prefix:MISS
First Name:ANGEL
Middle Name:BREAIL
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 1:7272 E 37TH ST N APT 701
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-3215
Mailing Address - Country:US
Mailing Address - Phone:405-875-2174
Mailing Address - Fax:
Practice Address - Street 1:2520 NW 39TH TER
Practice Address - Street 2:SUITE100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3730
Practice Address - Country:US
Practice Address - Phone:405-413-2077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKM0823645103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst