MEDICARE: DR. TENI MARGARET GARRETT-JOHNSON PH.D.

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	103TC0700X	Clinical Psychologist	PSY 23395	CA

General Provider Information

NPI Number	:	1518084557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TENI MARGARET GARRETT-JOHNSON PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 779
Second Line	:
City	:	PAHOA
State	:	HI
Zip	:	96778-0779
Country	:	US
Telephone Number	:	808-966-9174
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 AUPUNI ST
Second Line	:	SUITE 108
City	:	HILO
State	:	HI
Zip	:	96720-4246
Country	:	US
Telephone Number	:	808-987-7252
Fax Number	:

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	05/21/2010

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