Healthcare Provider Details

I. General information

NPI: 1225932304
Provider Name (Legal Business Name): MEGAN COLLEEN JOHNSON AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620A HOLLYWOOD BLVD
LOS ANGELES CA
90027-5408
US

IV. Provider business mailing address

1351 ELEMENTS WAY
IRVINE CA
92612-6545
US

V. Phone/Fax

Practice location:
  • Phone: 507-933-0884
  • Fax:
Mailing address:
  • Phone: 815-914-6304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number155314
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: