Provider Demographics
NPI:1083309082
Name:DR. LOREE A JOHNSON, MARRIAGE THERAPIST, INC
Entity Type:Organization
Organization Name:DR. LOREE A JOHNSON, MARRIAGE THERAPIST, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOREE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:310-625-9783
Mailing Address - Street 1:1601 PACIFIC COAST HWY STE 290
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3283
Mailing Address - Country:US
Mailing Address - Phone:310-625-9783
Mailing Address - Fax:310-698-0818
Practice Address - Street 1:1601 PACIFIC COAST HWY STE 290
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-3283
Practice Address - Country:US
Practice Address - Phone:310-625-9783
Practice Address - Fax:310-698-0818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty