Healthcare Provider Details

I. General information

NPI: 1477197481
Provider Name (Legal Business Name): AMY LORRAINE JOHNSON AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 SUNRISE AVE STE 200
ROSEVILLE CA
95661-4516
US

IV. Provider business mailing address

3050 FITE CIR STE 204
SACRAMENTO CA
95827-1807
US

V. Phone/Fax

Practice location:
  • Phone: 916-213-8172
  • Fax:
Mailing address:
  • Phone: 916-600-7887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number147401
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19632
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: