Organization
NICOLE M. JOHNSON, PSYD, LP, LLC
Active
Other names
River Vale Psychology Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICOLE M. JOHNSON PSYD LP LP (OWNER/LICENSED PSYCHOLOGIST)
(612) 249-0287
Entity
Organization
Contact information
Practice address
200 E TRAVELERS TRL STE 205, BURNSVILLE, MN 55337-4191
(612) 249-0269
(612) 249-8540
Mailing address
200 E TRAVELERS TRL STE 205, BURNSVILLE, MN 55337-4191
(612) 249-0269
(612) 249-8540
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1649893587
NPI II
MN
Enumeration date
05/27/2020
Last updated
09/11/2020
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