Provider Demographics
NPI:1609991249
Name:JOHNEN, COURTNEY (MS)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:JOHNEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 RALSTON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6051
Mailing Address - Country:US
Mailing Address - Phone:805-289-3100
Mailing Address - Fax:805-289-1676
Practice Address - Street 1:5740 RALSTON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6051
Practice Address - Country:US
Practice Address - Phone:805-289-3100
Practice Address - Fax:805-289-1676
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 49782106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist