Provider Information for 1497978654
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SETH A JOHNSON LCSW
Sex: Male
NPI: 1497978654
Last Updated: 2017-11-27
Certification Date:
Certification Date:
Details
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| NPI | 1497978654 | ||||||||
| Enumeration Date | 2007-04-10 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 401 N 14TH ST E RIVERTON, WY 82501-3821 United States Phone: 307-202-1483 | Fax: | ||||||||
| Primary Practice Address | 401 N 14TH ST E RIVERTON, WY 82501-3821 United States Phone: 307-202-1483 | Fax: | ||||||||
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