Provider Demographics
NPI:1639288434
Name:JOHNSON-FORD, CATHERINE MARIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:MARIA
Last Name:JOHNSON-FORD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:MARIA
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1221 W BEN WHITE BLVD STE 108A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7183
Mailing Address - Country:US
Mailing Address - Phone:512-842-2223
Mailing Address - Fax:512-494-0788
Practice Address - Street 1:1221 W BEN WHITE BLVD
Practice Address - Street 2:STE 108A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7183
Practice Address - Country:US
Practice Address - Phone:512-842-2223
Practice Address - Fax:512-494-0788
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25350103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0026JZOtherBCBS
TX1655045-03Medicaid
TX0026JZOtherBCBS