Healthcare Provider Details

I. General information

NPI: 1386306116
Provider Name (Legal Business Name): JUNKO JOHNSON MARRIAGE & FAMILY THERAPY PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 10/08/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25255 CABOT RD STE 228
LAGUNA HILLS CA
92653-5529
US

IV. Provider business mailing address

11 ARBORSIDE WAY
MISSION VIEJO CA
92692-5950
US

V. Phone/Fax

Practice location:
  • Phone: 949-432-6693
  • Fax: 949-298-3969
Mailing address:
  • Phone: 949-413-3350
  • Fax: 949-298-3969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JUNKO JOHNSON
Title or Position: PRESIDENT
Credential: LMFT
Phone: 949-432-6693