Healthcare Provider Details

I. General information

NPI: 1326898842
Provider Name (Legal Business Name): JOHANNA JONES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 E THOUSAND OAKS BLVD STE 103
THOUSAND OAKS CA
91360-7706
US

IV. Provider business mailing address

1 BOARDWALK AVE
THOUSAND OAKS CA
91360-5714
US

V. Phone/Fax

Practice location:
  • Phone: 805-341-5735
  • Fax:
Mailing address:
  • Phone: 805-341-5735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SOPHIE KATZ
Title or Position: THERAPIST
Credential: MA
Phone: 818-426-2980