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General NPI Number Information
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NPI Number | 1235304981
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Entity Type | Organization
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Legal Business Name | ROBERT E. JOHNSON, INC.
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 2579 HAMLINE AVE N SUITE D
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City | ROSEVILLE
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State | MN
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Zip | 55113-3186
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Country | US
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Telephone | 651-628-0947
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Fax | 651-636-2922
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Provider Business Mailing Address
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Address Line | 2579 HAMLINE AVE N SUITE D
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City | ROSEVILLE
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State | MN
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Zip | 55113-3186
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Country | US
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Telephone | 651-628-0947
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Fax | 651-636-2922
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | MR. ROBERT EDWARD JOHNSON
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Credential | M.A., L.P.
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Telephone | 651-628-0947
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | LP1796
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License Number State | MN
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