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General NPI Number Information
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NPI Number | 1023500436
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Entity Type | Organization
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Legal Business Name | CRYSTAL JOHNSON, PSY.D, LLC
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 939 W NORTH AVE STE 750
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City | CHICAGO
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State | IL
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Zip | 60642-7142
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Country | US
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Telephone | 773-844-2732
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Fax |
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Provider Business Mailing Address
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Address Line | 939 W NORTH AVE STE 750
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City | CHICAGO
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State | IL
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Zip | 60642-7142
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Country | US
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Telephone | 773-844-2732
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. CRYSTAL JOHNSON
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Credential | PSY.D.
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Telephone | 773-844-2732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.009543
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License Number State | IL
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