MEDICARE: DR. LEA LAFFOON JOHANSEN PSY.D., ABPP

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
1	103T00000X	Psychologist	PY 60192765	WA
2	103TC0700X	Clinical Psychologist	37582	TX
3	103TP0016X	Prescribing (Medical) Psychologist	305803	LA

General Provider Information

NPI Number	:	1255513834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEA LAFFOON JOHANSEN PSY.D., ABPP

Provider Business Mailing Address
First Line	:	48TH MDG/RAF LAKENHEATH
Second Line	:
City	:	APO
State	:	AE
Zip	:	09461
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	48TH MDG/RAF LAKENHEATH
Second Line	:
City	:	APO
State	:	AE
Zip	:	09461
Country	:	US
Telephone Number	:	314-226-8603
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	04/08/2026

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