Healthcare Provider Details

I. General information

NPI: 1548755911
Provider Name (Legal Business Name): PATRICE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 STOCKDALE HWY STE 275
BAKERSFIELD CA
93309-2667
US

IV. Provider business mailing address

5121 STOCKDALE HWY
BAKERSFIELD CA
93309-2656
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-5000
  • Fax: 661-836-8834
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number152804
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: