Provider Demographics
NPI:1568108744
Name:JOHNSON, ALEXANDER M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 E CARNOUSTIE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-5943
Mailing Address - Country:US
Mailing Address - Phone:805-264-4595
Mailing Address - Fax:
Practice Address - Street 1:1100 W SHAW AVE STE 112
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3708
Practice Address - Country:US
Practice Address - Phone:559-801-8944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33319103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical