MEDICARE: JOHNSON CHANG PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY19706	CA
2	103TF0200X	Forensic Psychologist	PSY	CA
3	103TP2701X	Group Psychotherapy Psychologist	PSY19706	CA
4	103T00000X	Psychologist	PY00003607	WA

General Provider Information

NPI Number	:	1144251471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNSON CHANG PSYD

Provider Business Mailing Address
First Line	:	9040A JACKSON AVE
Second Line	:
City	:	JOINT BASE LEWIS MCCHORD
State	:	WA
Zip	:	98431-1336
Country	:	US
Telephone Number	:	253-982-5709
Fax Number	:

Provider Business Practice Location Address
First Line	:	9040 JACKSON AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98431-1336
Country	:	US
Telephone Number	:	253-982-5709
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	04/25/2025

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Directions to “ JOHNSON CHANG PSYD” Practice Location

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