Provider Demographics
NPI:1114628591
Name:JOHNSON, KATRINA LYNN (AMFT, APCC)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7283
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93006-7283
Mailing Address - Country:US
Mailing Address - Phone:917-549-7889
Mailing Address - Fax:
Practice Address - Street 1:89 N HILL RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2437
Practice Address - Country:US
Practice Address - Phone:917-549-7889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137712106H00000X
CA13302101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional