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General NPI Number Information
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NPI Number | 1962648311
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Entity Type | Individual
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Provider Name | CHAD VERNON JOHNSON PHD
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Gender | Male
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Dates
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Enumeration Date | 01/06/2009
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Last Update Date | 01/06/2009
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Provider Practice Location Address
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Address Line | 1927 S BOSTON AVE #204
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City | TULSA
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State | OK
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Zip | 74119-5259
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Country | US
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Telephone | 918-406-6763
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Fax |
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Provider Business Mailing Address
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Address Line | 4502 E 41ST ST SCHUSTERMAN CENTER
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City | TULSA
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State | OK
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Zip | 74135-9923
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Country | US
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Telephone | 918-406-6763
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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 | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | 1070
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 1070
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 1070
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License Number State | OK
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