Active NPI
Patrick R Johnson, PH.D.
- Clinical Psychologist
- Seattle, WA
National Provider Identifier
1972603918
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1148
- Practice address
- 2901 NE Blakeley St
Suite 3B
Seattle, WA 98105-3164 - Phone
- (425) 238-9254
- NPI assigned
- Sep 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1148 | WA | Primary |
Addresses
Primary practice location
2901 NE Blakeley St
Suite 3B
Seattle, WA 98105-3164
Mailing address
2901 NE Blakeley St
Suite 3B
Seattle, WA 98105-3164
Phone (425) 238-9254
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1148 | WA | MD | Clinical Psychologist |
| 343 | MT | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Montana Neurobehavioral Specialists | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239062400000",
"number": "1972603918",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2901 NE BLAKELEY ST",
"address_2": "SUITE 3B",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981053164",
"telephone_number": "425-238-9254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2901 NE BLAKELEY ST",
"address_2": "SUITE 3B",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981053164",
"telephone_number": "425-238-9254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "PATRICK",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-22",
"last_updated": "2009-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "1148",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.