Provider Demographics
NPI:1639186448
Name:JOHNSEN, DAVID EDWIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDWIN
Last Name:JOHNSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 NW 138TH ST
Mailing Address - Street 2:STE. 201
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-2513
Mailing Address - Country:US
Mailing Address - Phone:405-755-8576
Mailing Address - Fax:405-755-6026
Practice Address - Street 1:3601 NW 138TH ST
Practice Address - Street 2:STE. 201
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-2513
Practice Address - Country:US
Practice Address - Phone:405-755-8576
Practice Address - Fax:405-755-6026
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK538103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical