Healthcare Provider Details

I. General information

NPI: 1437279965
Provider Name (Legal Business Name): KRISTY ANN JOHNSON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 GEER RD
TURLOCK CA
95382-2454
US

IV. Provider business mailing address

2101 GEER RD
TURLOCK CA
95382-2454
US

V. Phone/Fax

Practice location:
  • Phone: 209-664-8044
  • Fax: 209-526-0908
Mailing address:
  • Phone: 209-664-8044
  • Fax: 209-526-0908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number90676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: