Provider Demographics
NPI:1518258482
Name:JOHNSON, KATHERINE S (MFT)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 RYAN INDUSTRIAL CT
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1772
Mailing Address - Country:US
Mailing Address - Phone:510-962-2317
Mailing Address - Fax:
Practice Address - Street 1:125 RYAN INDUSTRIAL CT
Practice Address - Street 2:SUITE 114
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1772
Practice Address - Country:US
Practice Address - Phone:510-962-2317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39584106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist