Healthcare Provider Details

I. General information

NPI: 1629330444
Provider Name (Legal Business Name): ELIZABETH JOHNSON, PHD., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 E CACHE LA POUDRE ST
COLORADO SPRINGS CO
80909-4812
US

IV. Provider business mailing address

4860 ROBB ST STE 201
WHEAT RIDGE CO
80033-2162
US

V. Phone/Fax

Practice location:
  • Phone: 888-948-6789
  • Fax: 877-345-3501
Mailing address:
  • Phone: 303-278-7418
  • Fax: 888-341-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.0002384
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number397
License Number StateWY

VIII. Authorized Official

Name: DR. ELIZABETH JOHNSON
Title or Position: LICENSED PSYCHOLOGIST/OWNER
Credential: PHD.
Phone: 307-286-2851