=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174638506
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANICE CHARLENE JOHNSON PH.D.,LMFT,C.HT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1660 VIRGINIA RD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90019-5934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-734-9522
-----------------------------------------------------
Fax | 323-734-9522
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1660 VIRGINIA RD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90019-5934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-734-9522
-----------------------------------------------------
Fax | 323-734-9522
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFT6296
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------