Individual
GEORGETTE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
619 N BROADVIEW ST, CAPE GIRARDEAU, MO 63701-4313
(573) 334-3486
(573) 334-3524
Mailing address
2700 WEDGEWOOD DR, JACKSON, MO 63755-3251
(573) 334-7471
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
1999140485
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
146377
BLUE CROSS BLUE SHIELD
—
01
—
430142
CENTURY PLANNERS
—
01
—
43042
EPOCH
—
01
—
431823864
CORPHEALTH
MO
01
—
431823864
MAGELLAN
—
05
—
493874812
—
MO
01
—
5633811
FIRSTHEALTH
—
Enumeration date
05/20/2006
Last updated
05/01/2008
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