Individual
DR. GLEN LEE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
5123 N ROYAL DR, TRAVERSE CITY, MI 49684-9201
(231) 929-7358
(231) 935-0941
Mailing address
5123 N ROYAL DR, TRAVERSE CITY, MI 49684-9201
(231) 929-7358
(231) 935-0941
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301006001
MI
103TC0700X
Clinical Psychologist
PY7155
FL
Other
Enumeration date
05/18/2006
Last updated
07/08/2007
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