Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 012750 | MI |
N | 103G00000X | Clinical Psychologist | 012750 | MI |
N | 103TC0700X | Clinical Psychologist | 012750 | MI |
NPI | 1114145489 |
---|---|
Provider Name | Linda Bentley Johnson |
First Address | Ann Arbor, MI 48108-9584 |
Second Address | Farmington Hills, MI 48331-3440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |