Ellie I Johnson, PSYD
Individual provider Active NPI Clinical Psychologist · Represa, CA
NPI 1598087967 · NPPES record last updated Apr 19, 2013
Key facts
- NPI
- 1598087967
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY24135 (CA)
- Practice address
- 300 Prison Rd
Represa, CA 95671-0002 - Phone
- (916) 985-8610
- NPI assigned
- Feb 25, 2010
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY24135 | CA | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY24135 | CA | Yes |
Addresses
Primary practice location
300 Prison Rd
Represa, CA 95671-0002
Mailing address
PO Box 290002
Represa, CA 95671-0002
Phone (916) 985-8610
Other providers in Represa, CA
- Mark Hoffman
- Amy Louise Holliday
- Parker Douglas Houston
- Kayla Huynh
- Heather Jebananthan
- Robert Allen Johnson
- Harnek Singh Kahlon
- Stephen Lee Kansier
- Jamie Costello Kenwood
- Morgan Kissinger
All providers in Represa, CA · Clinical Psychologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 19, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.