Individual
DR. JACK ALLEN JOHNSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
7777 HENNESSY BLVD STE 501B, BATON ROUGE, LA 70808-4300
(225) 765-3456
(225) 765-5547
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(225) 765-3456
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
990
LA
103TB0200X
Cognitive & Behavioral Psychologist
990
LA
103TC0700X
Clinical Psychologist
Primary
990
LA
103TM1800X
Intellectual & Developmental Disabilities Psychologist
990
LA
Other
Enumeration date
05/20/2008
Last updated
04/20/2022
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