MEDICARE: DR. MARK ALAN JOHNSON PSYCHOLOGIST

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	LP2679	MN

General Provider Information

NPI Number	:	1598759342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ALAN JOHNSON PSYCHOLOGIST

Provider Business Mailing Address
First Line	:	PSC 41 BOX 677
Second Line	:	APO AE 09464
City	:	BRANDON
State	:	SUFFOLK
Zip	:	09464
Country	:	GB
Telephone Number	:	01366727917
Fax Number	:	144163528649

Provider Business Practice Location Address
First Line	:	RAF LAKENHEATH 48MDOS/SGOH
Second Line	:	UNIT 5210 BOX 230
City	:	BRANDON
State	:	SUFFOLK
Zip	:	APO AE 094610230
Country	:	GB
Telephone Number	:	441638528603
Fax Number	:	163-852-8649

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	07/08/2007

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