Healthcare Provider Details

I. General information

NPI: 1396149506
Provider Name (Legal Business Name): WILLIAM ZACH JOHNS MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18440 E RENWICK RD
AZUSA CA
91702-5922
US

IV. Provider business mailing address

2309 DALY ST
LOS ANGELES CA
90031-2230
US

V. Phone/Fax

Practice location:
  • Phone: 818-438-2678
  • Fax:
Mailing address:
  • Phone: 323-222-4591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW87025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: