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General NPI Number Information
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NPI Number | 1114164001
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Entity Type | Organization
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Legal Business Name | LIGHTEN YOUR LOAD, LLC
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Dates
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Enumeration Date | 01/14/2009
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Last Update Date | 01/16/2013
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Provider Practice Location Address
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Address Line | 1001 E WARNER RD SUITE 104
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City | TEMPE
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State | AZ
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Zip | 85284-3224
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Country | US
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Telephone | 480-268-9830
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Fax | 480-753-5421
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Provider Business Mailing Address
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Address Line | 1001 E WARNER RD SUITE 104
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City | TEMPE
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State | AZ
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Zip | 85284-3224
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Country | US
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Telephone | 480-268-9830
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Fax | 480-753-5421
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Authorized Official
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Title or Position | PSYCHOLOGIST/MANAGER
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Name | DR. MICHAEL EUGENE JOHNSON
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Credential | PH.D.
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Telephone | 480-268-9830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 3462
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License Number State | AZ
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