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General NPI Number Information
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NPI Number | 1306820915
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Entity Type | Individual
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Provider Name | RONALD STUART JOHNSON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 320 YOUNG RD 71 MDOS/SGOML BUILDING 248
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City | ENID
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State | OK
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Zip | 73705-5506
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Country | US
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Telephone | 580-213-7419
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Fax | 580-213-6423
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Provider Business Mailing Address
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Address Line | 3702 WILLOW LAKE LN
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City | ENID
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State | OK
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Zip | 73703-1417
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Country | US
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Telephone | 580-234-8817
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Fax |
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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 | 635
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License Number State | NM
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