Individual
RICHARD EARL JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
3109 6TH AVE, STE B, FORT WORTH, TX 76110-3800
(817) 846-8466
(817) 288-0958
Mailing address
3109 6TH AVE STE B, FORT WORTH, TX 76110-3800
(817) 846-8466
(817) 288-0958
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
25795
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0077TH
BCBS PROVIDER ID
TX
01
—
1008109
AMERIGROUP
UT
05
—
102647804
—
TX
05
—
102647805
—
TX
01
—
8B8909
BCBS
TX
Enumeration date
07/05/2006
Last updated
05/01/2024
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