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General NPI Number Information
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NPI Number | 1760510820
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Entity Type | Organization
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Legal Business Name | DEBRA A. JOHNSON, PH.D., A PSYCHOLOGY CORPORATION
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 02/07/2008
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Provider Practice Location Address
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Address Line | 610 14TH ST
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City | MODESTO
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State | CA
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Zip | 95354-2505
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Country | US
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Telephone | 209-524-4858
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Fax | 209-524-7780
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Provider Business Mailing Address
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Address Line | 615 15TH ST
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City | MODESTO
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State | CA
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Zip | 95354-2510
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Country | US
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Telephone | 209-527-4682
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Fax | 209-524-7780
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEBRA A JOHNSON
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Credential | PH. D.
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Telephone | 209-527-4682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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