Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Glen Lee Johnson, PHD

Individual provider Clinical Psychologist · NPI 1992758353

Dr. Glen Lee Johnson, PHD is a Clinical Psychologist in Traverse City, Michigan. Qualified in 1982, 44 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in Florida and Michigan.

Years since qualifying
44
Licensed in
FL, MI
In the registry since
2006
Specialties on file
2
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

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Practice location Address checks out

5123 N Royal Dr
Traverse City, MI 49684-9201
Phone: (231) 929-7358
Fax: (231) 935-0941
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence 6301006001 (MI)
Clinical Psychologist Taxonomy 103TC0700X · Licence PY7155 (FL)

Record details

NPI number1992758353
Entity typeIndividual (Type 1)
GenderMale
Credentials PHD
Sole proprietorYes
NPI enumeratedMay 18, 2006
Last updated in NPPESJuly 8, 2007

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 1982 (44 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Traverse City