Provider Demographics
NPI:1679851042
Name:THE JOHNSON CENTER FOR CHILD HEALTH AND DEVELOPMENT
Entity Type:Organization
Organization Name:THE JOHNSON CENTER FOR CHILD HEALTH AND DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-732-8400
Mailing Address - Street 1:1700 RIO GRANDE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1124
Mailing Address - Country:US
Mailing Address - Phone:512-732-8400
Mailing Address - Fax:512-732-8353
Practice Address - Street 1:1700 RIO GRANDE ST STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1124
Practice Address - Country:US
Practice Address - Phone:512-732-8400
Practice Address - Fax:512-732-8353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-10-6775103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty