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General NPI Number Information
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NPI Number | 1134423544
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Entity Type | Individual
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Provider Name | SUSAN L. JOHNSON L.M.F.T.
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Gender | Female
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Dates
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Enumeration Date | 12/28/2010
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Last Update Date | 12/28/2010
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Provider Practice Location Address
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Address Line | 2936 LAKE MARY DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84121-5331
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Country | US
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Telephone | 801-860-9627
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Fax | 801-266-4944
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Provider Business Mailing Address
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Address Line | 3900 SOUTH 220 EAST SUITE 6
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City | MURRAY
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State | UT
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Zip | 84107
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Country | US
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Telephone | 801-860-9627
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Fax | 801-266-4944
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 5943276-3902
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License Number State | UT
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