Individual
DR. PHILLIP JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
1500 E. WOODROW WILSON AVE., JACKSON, MS 39216-5116
(601) 362-4471
Mailing address
1500 E. WOODROW WILSON AVE., JACKSON, MS 39216-5116
(601) 362-4471
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
Primary
631163
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/08/2019
Last updated
06/14/2023
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