Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
N | 103G00000X | Clinical Psychologist | 20040870A | IN |
N | 103TC0700X | Clinical Psychologist | 20040870A | IN |
NPI | 1194880088 |
---|---|
Provider Name | Dr. Thomas James Johnson |
First Address | Terre Haute, IN 47809-0001 |
Second Address | Terre Haute, IN 47809-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 08/07/2007 |