MEDICARE: DAVID JOHNSEN PHD AND ASSOCIATES PLLC

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	538	OK

General Provider Information

NPI Number	:	1992959001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID JOHNSEN PHD AND ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	2601 NW EXPRESSWAY
Second Line	:	STE 410W
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7272
Country	:	US
Telephone Number	:	405-755-8576
Fax Number	:	405-755-6026

Provider Business Practice Location Address
First Line	:	2601 NW EXPRESSWAY
Second Line	:	STE 410W
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7272
Country	:	US
Telephone Number	:	405-755-8576
Fax Number	:	405-755-6026

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID EDWIN JOHNSEN
Credential	:	PH.D.
Telephone Number	:	405-755-8576

Provider Enumeration Date	:	11/17/2008
Last Update Date	:	12/23/2008

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