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NPI Code Detail

MEDICARE: CRYSTAL JOHNSON, PSY.D, LLC

MEDICARE: CRYSTAL JOHNSON, PSY.D, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist071.009543IL

General Provider Information

NPI Number : 1023500436
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRYSTAL JOHNSON, PSY.D, LLC
Provider Business Mailing Address
First Line : 939 W NORTH AVE STE 750
Second Line :
City : CHICAGO
State : IL
Zip : 60642-7142
Country : US
Telephone Number : 773-844-2732
Fax Number :
Provider Business Practice Location Address
First Line : 939 W NORTH AVE STE 750
Second Line :
City : CHICAGO
State : IL
Zip : 60642-7142
Country : US
Telephone Number : 773-844-2732
Fax Number :
Authorized Official
Title or Position : CLINICAL PSYCHOLOGIST
Name : DR. CRYSTAL JOHNSON
Credential : PSY.D.
Telephone Number : 773-844-2732
Provider Enumeration Date : 05/31/2018
Last Update Date : 05/31/2018

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