Healthcare Provider Details

I. General information

NPI: 1659015576
Provider Name (Legal Business Name): KRISTINE JOHNSON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25555 N WINDY WALK DR UNIT 51
SCOTTSDALE AZ
85255-8202
US

IV. Provider business mailing address

25555 N WINDY WALK DR UNIT 51
SCOTTSDALE AZ
85255-8202
US

V. Phone/Fax

Practice location:
  • Phone: 917-405-8816
  • Fax:
Mailing address:
  • Phone: 917-405-8816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4578-R
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-15892
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: