Provider Demographics
NPI:1457715450
Name:LYNN D. JOHNSON, PH.D., P.C.
Entity Type:Organization
Organization Name:LYNN D. JOHNSON, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-261-1412
Mailing Address - Street 1:166 E 5900 S
Mailing Address - Street 2:STE B-108
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7257
Mailing Address - Country:US
Mailing Address - Phone:801-261-1412
Mailing Address - Fax:801-288-2269
Practice Address - Street 1:166 E 5900 S
Practice Address - Street 2:STE B-108
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-7257
Practice Address - Country:US
Practice Address - Phone:801-261-1412
Practice Address - Fax:801-288-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty