Deswood Johnson Jr., BSW
Individual provider Active NPI Counselor · Thoreau, NM
NPI 1174809669 · NPPES record last updated Oct 27, 2011
Key facts
- NPI
- 1174809669
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- BLDG # T004-006 05 Miles East of 371
Thoreau, NM 87323 - Phone
- (505) 905-0062
- Fax
- (505) 905-0064
- NPI assigned
- Oct 27, 2011
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
BLDG # T004-006 05 Miles East of 371
Thoreau, NM 87323
Mailing address
211 S Florence St TRLR 48
Gallup, NM 87301-6763
Phone (505) 905-0061
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 860092335 | Other | NM | NAVAJO NATION |
Other providers in Thoreau, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 27, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.