Provider Demographics
NPI:1548472806
Name:JOHNSON-JIMENEZ, ERIKA K (PHD)
Entity type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:K
Last Name:JOHNSON-JIMENEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13170 CENTRAL AVE SE
Mailing Address - Street 2:SUITE B420
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123
Mailing Address - Country:US
Mailing Address - Phone:505-385-0161
Mailing Address - Fax:505-544-4648
Practice Address - Street 1:13170 CENTRAL AVE SE
Practice Address - Street 2:SUITE B420
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123
Practice Address - Country:US
Practice Address - Phone:505-385-0161
Practice Address - Fax:505-544-4648
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM0952103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM31731783Medicaid
NM31731783Medicaid