Provider Demographics
NPI:1851421986
Name:JOHNSON, ERIC STEVEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:STEVEN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3135
Mailing Address - Country:US
Mailing Address - Phone:614-325-9667
Mailing Address - Fax:
Practice Address - Street 1:659 HIGH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4173
Practice Address - Country:US
Practice Address - Phone:614-630-0038
Practice Address - Fax:614-436-4830
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5665103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical