Provider Demographics
NPI:1528396082
Name:JOHNSON NEUROPSYCHOLOGY, PLLC
Entity Type:Organization
Organization Name:JOHNSON NEUROPSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:469-549-4200
Mailing Address - Street 1:1422 W MAIN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3388
Mailing Address - Country:US
Mailing Address - Phone:469-549-4200
Mailing Address - Fax:469-549-4201
Practice Address - Street 1:1422 W MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3388
Practice Address - Country:US
Practice Address - Phone:469-549-4200
Practice Address - Fax:469-549-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2010-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32578103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty