MEDICARE: OLIVIA JOHNSON 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

General Provider Information

NPI Number	:	1669801874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA JOHNSON PSYD

Provider Business Mailing Address
First Line	:	2440 W SHAW AVE STE 203
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3300
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2440 W SHAW AVE STE 203
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3300
Country	:	US
Telephone Number	:	559-878-3189
Fax Number	:

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

Provider Enumeration Date	:	11/07/2013
Last Update Date	:	03/19/2024

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Directions to “ OLIVIA JOHNSON PSYD” Practice Location

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