| Stacy Kim Johnston Psychology, Inc. | |
|
501 W Broadway Ste 800 San Diego CA 92101-3546 | |
| (619) 077-8072 | |
| Not Available |
| Full Name | Stacy Kim Johnston Psychology, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 501 W Broadway Ste 800, San Diego, California |
| Authorized Official Name and Position | Stacy Johnston (OWNER) |
| Authorized Official Contact | 6190778072 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stacy Kim Johnston Psychology, Inc. 501 W Broadway Ste 800 San Diego CA 92101-3546 Ph: (619) 077-8072 | Stacy Kim Johnston Psychology, Inc. 501 W Broadway Ste 800 San Diego CA 92101-3546 Ph: (619) 077-8072 |
| NPI Number | 1316554322 |
|---|---|
| Provider Enumeration Date | 09/24/2020 |
| Last Update Date | 09/24/2020 |
| Certification Date | 09/24/2020 |
| Medicare PECOS PAC ID | 8527470004 |
|---|---|
| Medicare Enrollment ID | O20201208001351 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316554322 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Stacy K Johnston |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1063569135 PECOS PAC ID: 1153395298 Enrollment ID: I20040824000570 |
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