Healthcare Provider Details

I. General information

NPI: 1639333974
Provider Name (Legal Business Name): HELENA JOHNSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W STEWART DR SUITE 306
ORANGE CA
92868-3854
US

IV. Provider business mailing address

1310 W STEWART DR SUITE 306
ORANGE CA
92868-3854
US

V. Phone/Fax

Practice location:
  • Phone: 714-771-1404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY21216
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: