Provider Demographics
NPI:1528191038
Name:FLORES-JOHNSON, AMY JESSICA (MFTI)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JESSICA
Last Name:FLORES-JOHNSON
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 SANTA CLARA DR STE 145
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3500
Mailing Address - Country:US
Mailing Address - Phone:916-764-7045
Mailing Address - Fax:
Practice Address - Street 1:1624 SANTA CLARA DR STE 145
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3500
Practice Address - Country:US
Practice Address - Phone:916-779-2455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
CA92129106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health