Provider Demographics
NPI:1043015696
Name:JOHNSON, TREVON
Entity type:Individual
Prefix:
First Name:TREVON
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 CRUCIFER RD
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:TN
Mailing Address - Zip Code:38345-6987
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:530 SCARCE CREEK RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-8561
Practice Address - Country:US
Practice Address - Phone:731-610-3684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician