Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 60722639 | WA |
Y | 103T00000X | Psychologist | 60722639 | WA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 60722639 | WA |
N | 103G00000X | Clinical Psychologist | 60722639 | WA |
N | 103TC0700X | Clinical Psychologist | 60722639 | WA |
N | 103TC1900X | Counseling Psychologist | 60722639 | WA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 60722639 | WA |
N | 103TF0200X | Forensic Psychologist | 60722639 | WA |
NPI | 1083133490 |
---|---|
Provider Name | Nicole Rebecca Liu Johnson |
First Address | Lynnwood, WA 98036-7256 |
Second Address | Lynnwood, WA 98036-7256 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2017 |
Last Update Date | 18/09/2017 |