Healthcare Provider Details

I. General information

NPI: 1033033543
Provider Name (Legal Business Name): JENNIFER JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3336 E CHANDLER HEIGHTS RD STE 123
GILBERT AZ
85298-4263
US

IV. Provider business mailing address

7802 E QUARTET AVE
MESA AZ
85212-2635
US

V. Phone/Fax

Practice location:
  • Phone: 480-780-1209
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-24261
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: