Basic Information
| Provider Information | |||||||||
| NPI: | 1184257289 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | YULIYA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9340 NE 76TH ST | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986623721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602534912 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11411 BRIDGEPORT WAY SW | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984993047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535819002 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2020 | ||||||||
| LastUpdateDate: | 02/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PY61037213 | WA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | PY61037213 | 01 | WA | UHC | OTHER |