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General NPI Number Information
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NPI Number | 1174604169
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Entity Type | Individual
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Provider Name | PHILIP A JOHNSON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 11/17/2007
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Provider Practice Location Address
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Address Line | 325 MARKET ST SUITE 305-B
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City | CHATTANOOGA
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State | TN
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Zip | 37402-1226
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Country | US
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Telephone | 423-778-9455
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Fax | 423-267-2146
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Provider Business Mailing Address
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Address Line | 325 MARKET ST SUITE 305-B
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City | CHATTANOOGA
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State | TN
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Zip | 37402-1226
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Country | US
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Telephone | 423-778-9455
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Fax | 423-267-2146
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | P - 547
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | P - 547
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | P - 547
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | P - 547
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | P - 547
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License Number State | TN
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