Doctor Name: | MS. MICHAELA RENEE JOHNSON |
NPI Number: | 1528341039 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMFT |
License Number: | |
Business Practice Address: | 4224 Fowler Ln Diamond Springs, CA - 95619 |
Business Phone Number: | 5304013756 |
Business Fax Number: | |
Mailing Address: | 6300 Lookout Ln, KELSEY |
State: | CA |
Postal Code: | 956677407 |
Phone Number: | 5304013756 |
Fax Number: | |
NPI Enumeration Date: | 09/21/2011 |
NPI Last Update Date: | 11/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |