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General NPI Number Information
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NPI Number | 1497951933
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Entity Type | Individual
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Provider Name | CAMILLE JOHNSON LMFT
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Gender | Female
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 03/08/2020
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Provider Practice Location Address
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Address Line | 823 MURRAY AVE
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405
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Country | US
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Telephone | 805-704-4747
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Fax |
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Provider Business Mailing Address
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Address Line | 1411 MARSH ST STE 206
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-2991
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Country | US
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Telephone | 805-242-3691
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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