Provider Demographics
NPI:1063671444
Name:JOHNSON, ANTHONY RALPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:RALPH
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9010 RESEDA BLVD
Mailing Address - Street 2:#217-218
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-5862
Mailing Address - Country:US
Mailing Address - Phone:818-883-6935
Mailing Address - Fax:
Practice Address - Street 1:9010 RESEDA BLVD
Practice Address - Street 2:#217-218
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5862
Practice Address - Country:US
Practice Address - Phone:818-883-6935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC21531106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist