Healthcare Provider Details

I. General information

NPI: 1811763220
Provider Name (Legal Business Name): BRYAN CHRISTOPHER JOHNSON AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20051 SW BIRCH ST
NEWPORT BEACH CA
92660-1719
US

IV. Provider business mailing address

605 SAN MICHEL DR S UNIT B
COSTA MESA CA
92627-5840
US

V. Phone/Fax

Practice location:
  • Phone: 949-490-4052
  • Fax: 949-490-4053
Mailing address:
  • Phone: 646-717-4361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: