Healthcare Provider Details

I. General information

NPI: 1669335683
Provider Name (Legal Business Name): AMY JOHNSON LMFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 POLK ST STE 2
PORT TOWNSEND WA
98368-6739
US

IV. Provider business mailing address

210 POLK ST STE 2
PORT TOWNSEND WA
98368-6739
US

V. Phone/Fax

Practice location:
  • Phone: 360-505-7924
  • Fax:
Mailing address:
  • Phone: 360-505-7924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG61606691
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: