Individual
MS. AMANDA VICTORIA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
1901 E 1ST ST, NEWTON, KS 67114-5010
(316) 284-6400
Mailing address
8510 E 29TH ST N, APT. # 814, WICHITA, KS 67226-6602
(440) 668-7734
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
T-LMLP 1357
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T-LMLP 1357
TEMPORARY LICENSED MASTERS LEVEL PSYCHOLOGIST
KS
Enumeration date
08/05/2010
Last updated
08/05/2010
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