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General NPI Number Information
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NPI Number | 1407211626
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Entity Type | Individual
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Provider Name | JACKY CATHERINE JOHNSON LMFT
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Gender | Female
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Dates
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Enumeration Date | 12/16/2015
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Last Update Date | 01/21/2021
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Provider Practice Location Address
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Address Line | 5262 N 148TH AVE
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-2843
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Country | US
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Telephone | 503-484-5190
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Fax | 623-322-1838
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Provider Business Mailing Address
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Address Line | 5262 N 148TH AVE
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-2843
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Country | US
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Telephone | 503-484-5190
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Fax | 623-322-1838
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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 | LMFT-15214
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License Number State | AZ
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