Provider Demographics
NPI:1104844737
Name:JOHNSON, SUSAN N (MFT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:N
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 LEAFWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-1608
Mailing Address - Country:US
Mailing Address - Phone:530-210-9349
Mailing Address - Fax:916-772-8527
Practice Address - Street 1:8850 AUBURN FOLSOM RD
Practice Address - Street 2:SUITE A
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-6525
Practice Address - Country:US
Practice Address - Phone:530-210-9349
Practice Address - Fax:916-772-8527
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36678106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist