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General NPI Number Information
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NPI Number | 1235590258
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Entity Type | Individual
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Provider Name | ALYSA HARLESS JOHNSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/18/2016
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 14011 LODGEPOLE CT
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City | PENN VALLEY
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State | CA
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Zip | 95946-9128
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Country | US
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Telephone | 906-407-0047
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Fax | 916-405-4002
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Provider Business Mailing Address
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Address Line | 11354 PLEASANT VALLEY RD # 94
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City | PENN VALLEY
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State | CA
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Zip | 95946-9000
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Country | US
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Telephone | 906-407-0047
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 77484
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License Number State | CA
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