Healthcare Provider Details

I. General information

NPI: 1063999175
Provider Name (Legal Business Name): CLAYTON JAMES JOHNSON M.A., LMFT, DIR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2018
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 COMMUNITY AVE
LA CRESCENTA CA
91214-2522
US

IV. Provider business mailing address

2101 N GLENOAKS BLVD
BURBANK CA
91504-2828
US

V. Phone/Fax

Practice location:
  • Phone: 310-386-6670
  • Fax: 310-386-6670
Mailing address:
  • Phone: 818-848-8825
  • Fax: 818-848-8815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number107668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: