Healthcare Provider Details

I. General information

NPI: 1861487019
Provider Name (Legal Business Name): IRMA B JOHNSTON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 FAR HILLS AVE STE 304
OAKWOOD OH
45419-1687
US

IV. Provider business mailing address

2600 FAR HILLS AVE STE 304
OAKWOOD OH
45419-1687
US

V. Phone/Fax

Practice location:
  • Phone: 937-299-0636
  • Fax: 937-294-4669
Mailing address:
  • Phone: 937-299-0636
  • Fax: 937-294-4669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3652
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: