Healthcare Provider Details

I. General information

NPI: 1417866112
Provider Name (Legal Business Name): CORAL LYNN JOHNSON LPCC, PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 W SAN BERNARDINO RD STE 150
COVINA CA
91722-4156
US

IV. Provider business mailing address

1303 MAYWOOD AVE
UPLAND CA
91786-2542
US

V. Phone/Fax

Practice location:
  • Phone: 626-541-0009
  • Fax:
Mailing address:
  • Phone: 626-541-0009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC21251
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: