Basic Information
| Provider Information | |||||||||
| NPI: | 1003907049 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 440100 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372440100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153290570 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5653 FRIST BLVD | ||||||||
| Address2: | STE 434 | ||||||||
| City: | HERMITAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370762062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158719996 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 10/25/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | P1787 | TN | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 3980433 | 05 | TN | MEDICAID | 89620249 | 05 | KY | MEDICAID | 6194640 | 01 | UNITED BEHAVIORAL HEALTH | OTHER | 3123342 | 01 | TN | BCBS | OTHER | 151550 | 01 | VALUE OPTIONS | OTHER |