Provider Demographics
NPI:1629116082
Name:LAWRENCE J JOHNSON, PH.D. LLC
Entity Type:Organization
Organization Name:LAWRENCE J JOHNSON, PH.D. LLC
Other - Org Name:THE PSYCHOLOGY GROUP OF GR TOLEDO
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:419-535-1901
Mailing Address - Street 1:4159 HOLLAND SYLVANIA RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4803
Mailing Address - Country:US
Mailing Address - Phone:419-535-1901
Mailing Address - Fax:419-537-1922
Practice Address - Street 1:4159 HOLLAND SYLVANIA RD
Practice Address - Street 2:SUITE 203
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4803
Practice Address - Country:US
Practice Address - Phone:419-535-1901
Practice Address - Fax:419-537-1922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3453103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH065031Medicaid
OH065031Medicaid