Provider Demographics
NPI:1720844327
Name:JOHNSON, KARA M (PSYD)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 MIAMI RD STE 313
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-3750
Mailing Address - Country:US
Mailing Address - Phone:513-202-3625
Mailing Address - Fax:
Practice Address - Street 1:3914 MIAMI RD STE 313
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-3750
Practice Address - Country:US
Practice Address - Phone:513-202-3625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08586103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical