Healthcare Provider Details

I. General information

NPI: 1831890516
Provider Name (Legal Business Name): CAMDEN MARIE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 E CESAR CHAVEZ BLVD
FRESNO CA
93702-3604
US

IV. Provider business mailing address

4441 E CESAR CHAVEZ BLVD
FRESNO CA
93702-3604
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-9171
  • Fax:
Mailing address:
  • Phone: 559-600-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number138115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: