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NPI Code Detail

MEDICARE: JESSICA BETH JOHNSON MA, MFTI

MEDICARE: JESSICA BETH JOHNSON MA, MFTI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC 47746CA

General Provider Information

NPI Number : 1891852133
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA BETH JOHNSON MA, MFTI
Provider Business Mailing Address
First Line : 203 LOS BANOS AVE
Second Line :
City : WALNUT CREEK
State : CA
Zip : 94598-3131
Country : US
Telephone Number : 925-788-3103
Fax Number :
Provider Business Practice Location Address
First Line : 390 40TH ST
Second Line :
City : OAKLAND
State : CA
Zip : 94609-2633
Country : US
Telephone Number : 925-788-3103
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2007
Last Update Date : 08/11/2010

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