Provider Demographics
NPI:1467599514
Name:JOHNSON, DONALD ALFRED (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ALFRED
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 1:4601 SPICEWOOD SPRINGS RD
Mailing Address - Street 2:BLDG. 4, STE. 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8598
Mailing Address - Country:US
Mailing Address - Phone:512-467-1376
Mailing Address - Fax:512-467-8658
Practice Address - Street 1:4601 SPICEWOOD SPRINGS RD
Practice Address - Street 2:BLDG. 4, STE. 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8598
Practice Address - Country:US
Practice Address - Phone:512-467-1376
Practice Address - Fax:512-467-8658
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-3353103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist