Doctor Name: | ANGELINA MARIA JOHNSON |
NPI Number: | 1487084695 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D., TLP |
License Number: | T-LP 2182 |
Business Practice Address: | 1301 Ks Highway 264 Isaac Ray East 2 Larned, KS - 675505353 |
Business Phone Number: | 6202852131 |
Business Fax Number: | |
Mailing Address: | 1301 Ks Highway 264, Isaac Ray East 2 LARNED |
State: | KS |
Postal Code: | 675505353 |
Phone Number: | 6202852131 |
Fax Number: | |
NPI Enumeration Date: | 11/25/2013 |
NPI Last Update Date: | 11/25/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | T-LP 2182 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KS |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |