Healthcare Provider Details

I. General information

NPI: 1861737876
Provider Name (Legal Business Name): PERRI W JOHNSON, PSYCHOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2012
Last Update Date: 12/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11331 VENTURA BLVD 1D
STUDIO CITY CA
91604-3147
US

IV. Provider business mailing address

11331 VENTURA BLVD 1D
STUDIO CITY CA
91604-3147
US

V. Phone/Fax

Practice location:
  • Phone: 818-762-5560
  • Fax: 818-762-7919
Mailing address:
  • Phone: 818-762-5560
  • Fax: 818-762-7919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY14431
License Number StateCA

VIII. Authorized Official

Name: DR. PERRI JOHNSON JOHNSON
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 818-762-5560