Healthcare Provider Details

I. General information

NPI: 1356120620
Provider Name (Legal Business Name): ELIZABETH CHRISTINE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 TROOST AVE
KANSAS CITY MO
64108-1540
US

IV. Provider business mailing address

5 NORTH ST
LOUISBURG MO
65685-9147
US

V. Phone/Fax

Practice location:
  • Phone: 719-356-2737
  • Fax:
Mailing address:
  • Phone: 573-855-2668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2025012320
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: