Provider Demographics
NPI:1326636416
Name:JOHNSON-FORSETH, JUDY LORRAINE (RADT-I)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:LORRAINE
Last Name:JOHNSON-FORSETH
Suffix:
Gender:F
Credentials:RADT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 BEACH COURT
Mailing Address - Street 2:
Mailing Address - City:LOTUS
Mailing Address - State:CA
Mailing Address - Zip Code:95651-3415
Mailing Address - Country:US
Mailing Address - Phone:530-626-7252
Mailing Address - Fax:
Practice Address - Street 1:838 BEACH CT
Practice Address - Street 2:
Practice Address - City:COLOMA
Practice Address - State:CA
Practice Address - Zip Code:95667-4625
Practice Address - Country:US
Practice Address - Phone:530-626-7383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1414511220101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty