Provider Demographics
NPI:1508063694
Name:JOHNSON, DAVID W (MFC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32197 MEADOW RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COARSEGOLD
Mailing Address - State:CA
Mailing Address - Zip Code:93614-9559
Mailing Address - Country:US
Mailing Address - Phone:559-642-2987
Mailing Address - Fax:
Practice Address - Street 1:3097 WILLOW AVE STE 4
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-4715
Practice Address - Country:US
Practice Address - Phone:559-707-9212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35499106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist