Provider Demographics
NPI:1063034155
Name:JOHNSON, STEVEN LESLIE
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:LESLIE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0618
Mailing Address - Country:US
Mailing Address - Phone:530-243-7470
Mailing Address - Fax:530-243-7477
Practice Address - Street 1:1237 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0618
Practice Address - Country:US
Practice Address - Phone:530-243-7470
Practice Address - Fax:530-243-7477
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9676101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)