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General NPI Number Information
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NPI Number | 1033276258
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Entity Type | Organization
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Legal Business Name | ROMELLE A. JOHNSON, CLINICAL PSYCHOLOGY, LLC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7800 METRO PKWY SUITE 300
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1514
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Country | US
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Telephone | 952-853-9919
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Fax | 952-853-9929
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Provider Business Mailing Address
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Address Line | 7800 METRO PKWY SUITE 300
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1514
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Country | US
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Telephone | 952-853-9919
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Fax | 952-853-9929
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. ROMELLE JOHNSON
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Credential | PSYD, LP
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Telephone | 952-853-9919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP 3789
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License Number State | MN
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