Provider Demographics
NPI:1154560845
Name:PATRICIA DIANNE JOHNSON, PH.D., P.C.
Entity type:Organization
Organization Name:PATRICIA DIANNE JOHNSON, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-957-1471
Mailing Address - Street 1:4202 N 32ND ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-4746
Mailing Address - Country:US
Mailing Address - Phone:602-957-1471
Mailing Address - Fax:602-957-1632
Practice Address - Street 1:4202 N 32ND ST
Practice Address - Street 2:SUITE I
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-4746
Practice Address - Country:US
Practice Address - Phone:602-957-1471
Practice Address - Fax:602-957-1632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ127692Medicare PIN