Provider Demographics
NPI:1891245254
Name:JOHNSON, THOMAS CHRISTOPHER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CHRISTOPHER
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 1:130 N PRESTON RD STE 107
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-3185
Mailing Address - Country:US
Mailing Address - Phone:972-275-6880
Mailing Address - Fax:844-205-9001
Practice Address - Street 1:130 N PRESTON RD STE 107
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-3185
Practice Address - Country:US
Practice Address - Phone:972-275-6880
Practice Address - Fax:844-205-9001
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36671103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical