Provider Demographics
NPI:1881963700
Name:JOHNSON, DAVID PAUL (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3670 QUINCY AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1993
Mailing Address - Country:US
Mailing Address - Phone:801-781-5733
Mailing Address - Fax:801-899-6634
Practice Address - Street 1:3670 QUINCY AVE STE 105
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1993
Practice Address - Country:US
Practice Address - Phone:801-781-5733
Practice Address - Fax:801-899-6634
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-1295103TC0700X
UT9039444-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical