Provider Demographics
NPI:1497469696
Name:JOHNSON, KOURTNEY RENEE (AMFT)
Entity Type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:RENEE
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 1:44 GOUGH ST STE 304
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-5423
Mailing Address - Country:US
Mailing Address - Phone:707-718-0104
Mailing Address - Fax:
Practice Address - Street 1:44 GOUGH ST STE 104
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-5423
Practice Address - Country:US
Practice Address - Phone:415-621-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA138817106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist