Healthcare Provider Details

I. General information

NPI: 1346931508
Provider Name (Legal Business Name): KASHA M JOHNSON AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6902 SVL BOX
SPRING VALLEY LAKE CA
92395-5172
US

IV. Provider business mailing address

6902 SVL BOX
SPRING VALLEY LAKE CA
92395-5172
US

V. Phone/Fax

Practice location:
  • Phone: 310-930-4062
  • Fax:
Mailing address:
  • Phone: 310-930-4062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number154080
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: