Healthcare Provider Details

I. General information

NPI: 1851796254
Provider Name (Legal Business Name): KATHY JOHNSON MHRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 LINCOLN WAY
SAN FRANCISCO CA
94122-2210
US

IV. Provider business mailing address

170 9TH ST
SAN FRANCISCO CA
94103-2603
US

V. Phone/Fax

Practice location:
  • Phone: 415-664-1414
  • Fax: 415-664-7741
Mailing address:
  • Phone: 415-777-0333
  • Fax: 415-864-4042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1289390218
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: