Provider Demographics
NPI:1598759342
Name:JOHNSON, MARK ALAN (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:JOHNSON
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Gender:M
Credentials:PSYCHOLOGIST
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Mailing Address - Street 1:PSC 41 BOX 677
Mailing Address - Street 2:APO AE 09464
Mailing Address - City:BRANDON
Mailing Address - State:SUFFOLK
Mailing Address - Zip Code:09464
Mailing Address - Country:GB
Mailing Address - Phone:0136-672-7917
Mailing Address - Fax:14416-352-8649
Practice Address - Street 1:RAF LAKENHEATH 48MDOS/SGOH
Practice Address - Street 2:UNIT 5210 BOX 230
Practice Address - City:BRANDON
Practice Address - State:SUFFOLK
Practice Address - Zip Code:APO AE 094610230
Practice Address - Country:GB
Practice Address - Phone:44163-852-8603
Practice Address - Fax:163-852-8649
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MNLP2679103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical