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General NPI Number Information
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NPI Number | 1962155267
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Entity Type | Individual
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Provider Name | EFFIE LEIGH JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 01/27/2022
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 4090 BRIARGATE PKWY
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-7815
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Country | US
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Telephone | 719-305-9437
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Fax |
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Provider Business Mailing Address
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Address Line | 2508 E SAN MIGUEL ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-4004
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Country | US
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Telephone | 719-271-0465
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0009923676
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License Number State | CO
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