Provider Demographics
NPI:1265658066
Name:JOHNSON, CHRISTOPHER KIRK (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:KIRK
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2752
Mailing Address - Country:US
Mailing Address - Phone:360-694-2016
Mailing Address - Fax:360-694-8990
Practice Address - Street 1:3112 MAIN ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2752
Practice Address - Country:US
Practice Address - Phone:360-694-2016
Practice Address - Fax:360-694-8990
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA813103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic