Individual
EMILY THOMAS JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
5779 GETWELL RD STE 3, SOUTHAVEN, MS 38672-6347
(662) 510-6507
(844) 445-7727
Mailing address
4628 UNION RD, SARDIS, MS 38666-3280
(662) 487-3188
(662) 487-3188
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
150002
MS
103TC0700X
Clinical Psychologist
Primary
46-757
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02937543
—
MS
05
—
Q061267
—
TN
Enumeration date
05/16/2007
Last updated
02/22/2021
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