Healthcare Provider Details

I. General information

NPI: 1508063694
Provider Name (Legal Business Name): DAVID W JOHNSON MFC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3097 WILLOW AVE STE 4
CLOVIS CA
93612-4715
US

IV. Provider business mailing address

32197 MEADOW RIDGE RD
COARSEGOLD CA
93614-9559
US

V. Phone/Fax

Practice location:
  • Phone: 559-707-9212
  • Fax:
Mailing address:
  • Phone: 559-642-2987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC35499
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: