Provider Demographics
NPI:1871503995
Name:JOHNSON, CURT L (PHD LP)
Entity Type:Individual
Prefix:
First Name:CURT
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 VETERANS DR
Mailing Address - Street 2:ST CLOUD VA MEDICAL CENTER
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2015
Mailing Address - Country:US
Mailing Address - Phone:218-839-4785
Mailing Address - Fax:218-829-9555
Practice Address - Street 1:4801 VETERANS DR
Practice Address - Street 2:ST CLOUD VA MEDICAL CENTER
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2015
Practice Address - Country:US
Practice Address - Phone:218-839-4785
Practice Address - Fax:218-829-9555
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1517103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN62G70JOOtherBCBS
MN6101305OtherMEDICA
MN633252800Medicaid
MN850261OtherARAZ
MN850261OtherARAZ