Provider Demographics
NPI:1114097946
Name:JOHNSON, JANA KAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANA
Middle Name:KAY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41865 BOARDWALK
Mailing Address - Street 2:SUITE 215
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-9026
Mailing Address - Country:US
Mailing Address - Phone:760-341-6655
Mailing Address - Fax:760-341-6685
Practice Address - Street 1:41865 BOARDWALK
Practice Address - Street 2:SUITE 215
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-9026
Practice Address - Country:US
Practice Address - Phone:760-341-6655
Practice Address - Fax:760-341-6685
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18487103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P66080Medicare UPIN
CAOPL184870Medicare ID - Type Unspecified