Healthcare Provider Details

I. General information

NPI: 1841290236
Provider Name (Legal Business Name): NORAH ALICE JOHNSON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 TEBBETTS AVENUE
BELLE MO
65013
US

IV. Provider business mailing address

706 TEBBETTS AVENUE PO BOX 326
BELLE MO
65013
US

V. Phone/Fax

Practice location:
  • Phone: 573-859-3744
  • Fax:
Mailing address:
  • Phone: 573-859-3744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberR0500
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: