Basic Information
| Provider Information | |||||||||
| NPI: | 1750904645 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | CHELSEA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6910 S HIGHLAND DR | ||||||||
| Address2: | |||||||||
| City: | COTTONWOOD HEIGHTS | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841213060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004348923 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6910 S HIGHLAND DR | ||||||||
| Address2: | |||||||||
| City: | COTTONWOOD HEIGHTS | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841213060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004348923 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2020 | ||||||||
| LastUpdateDate: | 05/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | UT | N | Behavioral Health & Social Service Providers | Psychologist | 106E00000X | UT | N | 106S00000X | UT | N | 103K00000X | UT | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.