Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | P1787 | TN |
Y | 103TC0700X | Clinical Psychologist | P1787 | TN |
NPI | 1003907049 |
---|---|
Provider Name | Amy H Johnson |
First Address | Nashville, TN 37244-0100 |
Second Address | Hermitage, TN 37076-2062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 25/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
151550 | VALUE OPTIONS (01) | |
3123342 | BCBS (01) | TN |
3980433 | (05) | TN |
6194640 | UNITED BEHAVIORAL HEALTH (01) | |
89620249 | (05) | KY |
S76374 | (02) |