Provider Demographics
NPI:1407884588
Name:BERIT B. JOHNSON, PH.D.
Entity Type:Organization
Organization Name:BERIT B. JOHNSON, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BERIT
Authorized Official - Middle Name:BAILEY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-215-2499
Mailing Address - Street 1:3100 CARLISLE ST STE 106
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-0991
Mailing Address - Country:US
Mailing Address - Phone:214-215-2499
Mailing Address - Fax:214-720-0073
Practice Address - Street 1:3100 CARLISLE ST STE 106
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-0991
Practice Address - Country:US
Practice Address - Phone:214-215-2499
Practice Address - Fax:214-720-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32099103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32099OtherPSYCHOLOGY LICENSE NUMBER
TX00828HMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER