Provider Demographics
NPI:1083016513
Name:JOHNSON, DANIEL E (PSYD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1843 AUSTIN BLUFFS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-7857
Mailing Address - Country:US
Mailing Address - Phone:719-291-9609
Mailing Address - Fax:866-488-5608
Practice Address - Street 1:1843 AUSTIN BLUFFS PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-7857
Practice Address - Country:US
Practice Address - Phone:719-291-9609
Practice Address - Fax:866-488-5608
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY0004355103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist