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General NPI Number Information
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NPI Number | 1184004798
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Entity Type | Individual
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Provider Name | TIMOTHY MICHAEL JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 06/09/2015
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 2460 W 3RD ST STE 230
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City | SANTA ROSA
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State | CA
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Zip | 95401
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Country | US
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Telephone | 707-806-9482
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Fax | 833-211-1388
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Provider Business Mailing Address
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Address Line | PO BOX 112
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City | OCCIDENTAL
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State | CA
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Zip | 95465-0112
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Country | US
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Telephone | 707-806-9482
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Fax |
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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 |
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License Number State |
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