Provider Demographics
NPI:1164286308
Name:JOHNSON, YASHI AMITA (MFC20553)
Entity Type:Individual
Prefix:DR
First Name:YASHI
Middle Name:AMITA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MFC20553
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11486 N BLOOMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-9248
Mailing Address - Country:US
Mailing Address - Phone:530-277-5477
Mailing Address - Fax:
Practice Address - Street 1:11486 N BLOOMFIELD RD
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-9248
Practice Address - Country:US
Practice Address - Phone:530-277-5477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT20553101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health