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NICOLE M. JOHNSON PSYD LP LLC NPI 1649893587


NPI Information

NPI: 1649893587
Provider Name: NICOLE M. JOHNSON, PSYD, LP, LLC

Doing Business As: RIVER VALE PSYCHOLOGY CLINIC

Classification: Psychologist - 103TC0700X
Entity Type: Organization

Specialization: Clinical

Address:
200 E TRAVELERS TRL STE 205
BURNSVILLE, MN
ZIP 55337
Phone: (612) 249-0269
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NICOLE M. JOHNSON, PSYD, LP, LLC is a clinical psychologist in Burnsville, MN. The provider is a psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems. NICOLE M. JOHNSON, PSYD, LP, LLC NPI is 1649893587. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As River Vale Psychology Clinic.

The provider's business location address is:

200 E TRAVELERS TRL STE 205
BURNSVILLE, MN
ZIP 55337-191
Phone: (612) 249-0269
Fax: (612) 249-8540

The provider's authorized official is Nicole M. Johnson Psyd Lp .
The authorized official title is Owner/licensed Psychologist and has the following contact phone number (612) 249-0287.

The enumeration date for this NPI number is 5/27/2020 and was last updated on 9/11/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1103TB0200XPsychologistCognitive & BehavioralNo
2103TC2200XPsychologistClinical Child & AdolescentNo
3103TC0700XPsychologistClinicalYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11649893587OTHERMINNESOTANPI II

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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