Basic Information
| Provider Information | |||||||||
| NPI: | 1629330444 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELIZABETH JOHNSON, PHD., LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4860 ROBB ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800332162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032787418 | ||||||||
| FaxNumber: | 8883415050 | ||||||||
| Practice Location | |||||||||
| Address1: | 2445 E CACHE LA POUDRE ST | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809094812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889486789 | ||||||||
| FaxNumber: | 8773453501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2012 | ||||||||
| LastUpdateDate: | 12/28/2020 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | LICENSED PSYCHOLOGIST/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3072862851 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD. | ||||||||
| NPICertificationDate: | 12/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 397 | WY | N | Agencies | Community/Behavioral Health | 103TC0700X | PSY.0002384 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.