Healthcare Provider Details

I. General information

NPI: 1811475957
Provider Name (Legal Business Name): PRISCILLA GREGORIA JOHNSON-ESPARZA AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 TRUXTUN AVE
BAKERSFIELD CA
93301-3137
US

IV. Provider business mailing address

PO BOX 1000
BAKERSFIELD CA
93302-1000
US

V. Phone/Fax

Practice location:
  • Phone: 916-996-4560
  • Fax:
Mailing address:
  • Phone: 661-868-6840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number146003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: