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NPI Code Detail

MEDICARE: ELIZABETH JOHNSON, PHD., LLC

MEDICARE: ELIZABETH JOHNSON, PHD., LLC
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
1251S00000XCommunity/Behavioral Health Agency397WY
2103TC0700XClinical PsychologistPSY.0002384CO

General Provider Information

NPI Number : 1629330444
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELIZABETH JOHNSON, PHD., LLC
Provider Business Mailing Address
First Line : 4860 ROBB ST STE 201
Second Line :
City : WHEAT RIDGE
State : CO
Zip : 80033-2162
Country : US
Telephone Number : 303-278-7418
Fax Number : 888-341-5050
Provider Business Practice Location Address
First Line : 2445 E CACHE LA POUDRE ST
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80909-4812
Country : US
Telephone Number : 888-948-6789
Fax Number : 877-345-3501
Authorized Official
Title or Position : LICENSED PSYCHOLOGIST/OWNER
Name : DR. ELIZABETH JOHNSON
Credential : PHD.
Telephone Number : 307-286-2851
Provider Enumeration Date : 06/08/2012
Last Update Date : 12/28/2020

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