Provider Demographics
NPI:1548577869
Name:JOHNSON, MATTHEW JAMES (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JAMES
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 551
Mailing Address - Street 2:
Mailing Address - City:ANGELS CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95222-0551
Mailing Address - Country:US
Mailing Address - Phone:209-352-1828
Mailing Address - Fax:
Practice Address - Street 1:3715 HIGHWAY 4
Practice Address - Street 2:
Practice Address - City:VALLECITO
Practice Address - State:CA
Practice Address - Zip Code:95251
Practice Address - Country:US
Practice Address - Phone:209-352-1828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 83183106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist