Provider Demographics
NPI:1477197481
Name:JOHNSON, AMY LORRAINE (AMFT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LORRAINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:AMFT
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 13202
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95813-3202
Mailing Address - Country:US
Mailing Address - Phone:916-420-7058
Mailing Address - Fax:
Practice Address - Street 1:3947 LENNANE DR STE 110
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1971
Practice Address - Country:US
Practice Address - Phone:916-283-8280
Practice Address - Fax:916-283-8259
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 101YP2500X, 1041C0700X, 171M00000X
CA107988106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator