Provider Demographics
NPI:1639146764
Name:JOHNSON-JULIAN, ANNICE MYNNETTE SR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANNICE
Middle Name:MYNNETTE
Last Name:JOHNSON-JULIAN
Suffix:SR
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5235 GLENDON ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-8437
Mailing Address - Country:US
Mailing Address - Phone:801-263-9368
Mailing Address - Fax:
Practice Address - Street 1:5235 GLENDON ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-8402
Practice Address - Country:US
Practice Address - Phone:801-263-9368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT365139-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical