Provider Demographics
NPI:1306037445
Name:JOHNSON, ROBERT ERIC (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ERIC
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3150 HORTON RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:TX
Mailing Address - Zip Code:76119-5905
Mailing Address - Country:US
Mailing Address - Phone:817-413-3274
Mailing Address - Fax:
Practice Address - Street 1:3150 HORTON RD
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:TX
Practice Address - Zip Code:76119-5905
Practice Address - Country:US
Practice Address - Phone:817-413-3274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY61114622103TC0700X
WI1981103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist