Provider Demographics
NPI:1801363692
Name:HEATHER JOHNSON PSYCHOLOGY, LLC
Entity Type:Organization
Organization Name:HEATHER JOHNSON PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEECHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-676-2069
Mailing Address - Street 1:7799 JOAN DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-3682
Mailing Address - Country:US
Mailing Address - Phone:513-704-5746
Mailing Address - Fax:
Practice Address - Street 1:7799 JOAN DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3682
Practice Address - Country:US
Practice Address - Phone:513-704-5746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty