Provider Demographics
NPI:1992413009
Name:JOHNSON, GREGORY SCOTT (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:SCOTT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15050 INDIAN HILLS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-8288
Mailing Address - Country:US
Mailing Address - Phone:614-296-1730
Mailing Address - Fax:
Practice Address - Street 1:15050 INDIAN HILLS RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-8288
Practice Address - Country:US
Practice Address - Phone:614-296-1730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6896103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty