Healthcare Provider Details

I. General information

NPI: 1689370033
Provider Name (Legal Business Name): AMBER JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16250 VENTURA BLVD STE 465
ENCINO CA
91436-4620
US

IV. Provider business mailing address

950 N DUESENBERG DR APT 2312
ONTARIO CA
91764-5968
US

V. Phone/Fax

Practice location:
  • Phone: 818-906-0406
  • Fax:
Mailing address:
  • Phone: 951-752-3717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162862
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: