Provider Demographics
NPI:1992959001
Name:DAVID JOHNSEN PHD AND ASSOCIATES PLLC
Entity type:Organization
Organization Name:DAVID JOHNSEN PHD AND ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:JOHNSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-755-8576
Mailing Address - Street 1:2601 NW EXPRESSWAY
Mailing Address - Street 2:STE 410W
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7272
Mailing Address - Country:US
Mailing Address - Phone:405-755-8576
Mailing Address - Fax:405-755-6026
Practice Address - Street 1:2601 NW EXPRESSWAY
Practice Address - Street 2:STE 410W
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7272
Practice Address - Country:US
Practice Address - Phone:405-755-8576
Practice Address - Fax:405-755-6026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK538103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty