Provider Demographics
NPI:1053025189
Name:JOHNSON, WILLIE HOWARD
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:HOWARD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BJC BEHAVIORAL HEALTH
Mailing Address - Street 2:1430 OLIVE STE 400
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-2303
Mailing Address - Country:US
Mailing Address - Phone:314-320-7414
Mailing Address - Fax:
Practice Address - Street 1:BJC LEARNING INSTITUTE
Practice Address - Street 2:8300 EAGER ROAD 2ND FLOOR
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144
Practice Address - Country:US
Practice Address - Phone:314-362-0983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical