Healthcare Provider Details

I. General information

NPI: 1518239979
Provider Name (Legal Business Name): MS. LYNDEE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4129 STATE ST STE B
SANTA BARBARA CA
93110-2853
US

IV. Provider business mailing address

5047 SANTA SUSANA AVE
SANTA BARBARA CA
93111-2141
US

V. Phone/Fax

Practice location:
  • Phone: 805-964-4795
  • Fax:
Mailing address:
  • Phone: 805-280-1789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: