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General NPI Number Information
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NPI Number | 1588140941
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Entity Type | Individual
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Provider Name | KELSEY JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 07/18/2018
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Last Update Date | 11/16/2024
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Provider Practice Location Address
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Address Line | 1495 GREENFIELD DR
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City | EL CAJON
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State | CA
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Zip | 92021-3414
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Country | US
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Telephone | 619-588-3103
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Fax |
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Provider Business Mailing Address
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Address Line | 750 E MAIN ST
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City | EL CAJON
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State | CA
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Zip | 92020-4012
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Country | US
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Telephone | 619-588-3005
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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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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 14920
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License Number State | CA
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