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General NPI Number Information
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NPI Number | 1427256239
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Entity Type | Organization
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Legal Business Name | TERRENCE J JOHNSON PH D PC
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 07/08/2009
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Provider Practice Location Address
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Address Line | 802 W KING ST SUITE P.
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City | OWOSSO
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State | MI
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Zip | 48867-2100
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Country | US
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Telephone | 989-723-1120
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Fax | 989-729-6506
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Provider Business Mailing Address
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Address Line | 802 W KING ST SUITE P.
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City | OWOSSO
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State | MI
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Zip | 48867-2100
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Country | US
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Telephone | 989-723-1120
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Fax | 989-729-6506
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TERRENCE JOSEPH JOHNSON
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Credential | PH D
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Telephone | 989-723-1120
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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 | 6301002671
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801019150
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4101005346
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301002288
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License Number State | MI
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