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General NPI Number Information
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NPI Number | 1053614131
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Entity Type | Organization
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Legal Business Name | CALM-CLINIC FOR ATTENTION, LEARNING, AND MEMOR
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 12/29/2010
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Provider Practice Location Address
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Address Line | 1409 WILLOW ST SUITE 600
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City | MINNEAPOLIS
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State | MN
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Zip | 55403-2269
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Country | US
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Telephone | 612-872-9072
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Fax | 612-872-8605
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Provider Business Mailing Address
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Address Line | 1409 WILLOW ST #600
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City | MINNEAPOLIS
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State | MN
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Zip | 55403
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Country | US
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Telephone | 612-872-2343
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Fax | 612-872-4279
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Authorized Official
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Title or Position | OWNER & PRESIDENT
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Name | DR. GARY GENE JOHNSON
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Credential | PHD
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Telephone | 612-419-3266
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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 | LP1794
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License Number State | MN
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