1225300957 NPI number — SHIRLEY KAY JOHNSON LICENSED GRIEF COUNS

Table of content: SHIRLEY KAY JOHNSON LICENSED GRIEF COUNS (NPI 1225300957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225300957 NPI number — SHIRLEY KAY JOHNSON LICENSED GRIEF COUNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
SHIRLEY
Provider Middle Name:
KAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICENSED GRIEF COUNS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225300957
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 RUBY CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILBERTSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19525-8414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-680-5098
Provider Business Mailing Address Fax Number:
610-367-0101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 GROSSER RD STE 2A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILBERTSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19525-9225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-680-5098
Provider Business Practice Location Address Fax Number:
610-367-0101
Provider Enumeration Date:
01/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  CERTIFIED GRIEF COUN , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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