Healthcare Provider Details

I. General information

NPI: 1972884641
Provider Name (Legal Business Name): JULIA M JOHNSON LEP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 JOYCE DR
BREA CA
92821-2217
US

IV. Provider business mailing address

920 JOYCE DR
BREA CA
92821-2217
US

V. Phone/Fax

Practice location:
  • Phone: 714-293-8627
  • Fax:
Mailing address:
  • Phone: 714-293-8627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberLEP 2268
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLEP 2268
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLEP 2268
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: