Provider Demographics
NPI:1326356627
Name:JOHNSON, MARSHA Y (MS)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:Y
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21250 BOX SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-8705
Mailing Address - Country:US
Mailing Address - Phone:951-369-8036
Mailing Address - Fax:
Practice Address - Street 1:21250 BOX SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-8705
Practice Address - Country:US
Practice Address - Phone:951-369-8036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 63012106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist