Provider Demographics
NPI:1164593943
Name:JOHNSON, SCOTT A (PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28490 AVE. STANFORD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-0921
Mailing Address - Country:US
Mailing Address - Phone:661-435-5786
Mailing Address - Fax:
Practice Address - Street 1:28490 AVENUE STANFORD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-0921
Practice Address - Country:US
Practice Address - Phone:661-435-5786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19151103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical