Provider Demographics
NPI:1851427694
Name:ERIC RICHARD JOHNSON
Entity Type:Organization
Organization Name:ERIC RICHARD JOHNSON
Other - Org Name:A PROFESSIONAL ASSOCIATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:360-770-8487
Mailing Address - Street 1:1330A S 2ND ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-4822
Mailing Address - Country:US
Mailing Address - Phone:360-770-8487
Mailing Address - Fax:360-336-3315
Practice Address - Street 1:1330A S 2ND ST STE 102
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-4822
Practice Address - Country:US
Practice Address - Phone:360-770-8487
Practice Address - Fax:360-336-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003649251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health