Individual
NICOLE REBECCA LIU JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
20826 2ND AVE W, LYNNWOOD, WA 98036-7256
(925) 548-2863
(925) 548-2863
Mailing address
20826 2ND AVE W, LYNNWOOD, WA 98036-7256
(925) 548-2863
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
60722639
WA
103TB0200X
Cognitive & Behavioral Psychologist
60722639
WA
103TC0700X
Clinical Psychologist
60722639
WA
103TC1900X
Counseling Psychologist
60722639
WA
103TC2200X
Clinical Child & Adolescent Psychologist
60722639
WA
103TF0200X
Forensic Psychologist
60722639
WA
Other
Enumeration date
09/18/2017
Last updated
09/18/2017
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