Provider Demographics
NPI:1548391576
Name:JOHNSON, SEVET ELAINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SEVET
Middle Name:ELAINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:SEVET
Other - Middle Name:ELAINE
Other - Last Name:PREACELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1911 WILLIAMS DR STE 120
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-2612
Mailing Address - Country:US
Mailing Address - Phone:805-814-8117
Mailing Address - Fax:
Practice Address - Street 1:1911 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2612
Practice Address - Country:US
Practice Address - Phone:805-981-9270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF51428106H00000X
CAPSY24219103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist