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General NPI Number Information
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NPI Number | 1437679644
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Entity Type | Individual
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Provider Name | TIMOTHY JOHANSSON SR. PSYD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2395 UNIVERSITY AVE W STE 200
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City | SAINT PAUL
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State | MN
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Zip | 55114-1511
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Country | US
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Telephone | 651-592-6788
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Fax |
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Provider Business Mailing Address
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Address Line | 2395 UNIVERSITY AVE W STE 200
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City | SAINT PAUL
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State | MN
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Zip | 55114-1511
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Country | US
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Telephone | 651-592-6788
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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