Healthcare Provider Details

I. General information

NPI: 1720124928
Provider Name (Legal Business Name): KEVEL IVONDA JOHNSON M.S., MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 W HERNDON AVE #300
FRESNO CA
93711-0552
US

IV. Provider business mailing address

5352 COVEY RUN CT
LAS VEGAS NV
89139-7453
US

V. Phone/Fax

Practice location:
  • Phone: 559-256-2000
  • Fax: 559-256-3000
Mailing address:
  • Phone: 559-903-7151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMI1143
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1143
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: