Active NPI
Nicole Rebecca Liu Johnson, PSYD
- Psychologist
- Lynnwood, WA
National Provider Identifier
1083133490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 60722639
- Practice address
- 20826 2ND Ave W
Lynnwood, WA 98036-7256 - Phone
- (925) 548-2863
- Fax
- (925) 548-2863
- NPI assigned
- Sep 18, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | 60722639 | WA | |
| Clinical Psychologist | 103TC0700X | 60722639 | WA | |
| Counseling Psychologist | 103TC1900X | 60722639 | WA | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 60722639 | WA | |
| Forensic Psychologist | 103TF0200X | 60722639 | WA | |
| Psychologist | 103T00000X | 60722639 | WA | Primary |
Addresses
Primary practice location
20826 2ND Ave W
Lynnwood, WA 98036-7256
Mailing address
20826 2ND Ave W
Lynnwood, WA 98036-7256
Phone (925) 548-2863
Other names 1
- Dr. Nikki Rebecca Liu Johnson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60722639 | WA | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1505692800000",
"number": "1083133490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20826 2ND AVE W",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980367256",
"telephone_number": "925-548-2863"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20826 2ND AVE W",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980367256",
"telephone_number": "925-548-2863",
"fax_number": "925-548-2863"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "NICOLE",
"middle_name": "REBECCA LIU",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-18",
"last_updated": "2017-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "WA",
"license": "60722639",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "60722639",
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "WA",
"license": "60722639",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "WA",
"license": "60722639",
"primary": false
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "WA",
"license": "60722639",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WA",
"license": "60722639",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "NIKKI",
"last_name": "JOHNSON",
"middle_name": "REBECCA LIU",
"prefix": "DR.",
"credential": "PSYD",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Lynnwood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.