Provider Demographics
NPI:1841242575
Name:JOHNSON, PATRICIA I (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:I
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 N NORTHSIGHT BLVD
Mailing Address - Street 2:SUITE 229
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3672
Mailing Address - Country:US
Mailing Address - Phone:480-315-9565
Mailing Address - Fax:480-315-9564
Practice Address - Street 1:14300 N NORTHSIGHT BLVD
Practice Address - Street 2:SUITE 229
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3672
Practice Address - Country:US
Practice Address - Phone:480-315-9565
Practice Address - Fax:480-315-9564
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0441103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS14919Medicare UPIN