Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 20042500A | IN |
Y | 103G00000X | Clinical Psychologist | 20042500A | IN |
Y | 103TC0700X | Clinical Psychologist | 20042500A | IN |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 20042500A | IN |
NPI | 1316244627 |
---|---|
Provider Name | Dr. Michael Anthony Johnson |
First Address | Indianapolis, IN 46220-1927 |
Second Address | Indianapolis, IN 46220-1927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2011 |
Last Update Date | 14/09/2016 |