Provider Demographics
NPI:1619506235
Name:JOHNSON, STACI R (LMHC, LPCC)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMHC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BOMBAY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-4806
Mailing Address - Country:US
Mailing Address - Phone:317-316-2787
Mailing Address - Fax:
Practice Address - Street 1:7700 IRVINE CENTER DR STE 800
Practice Address - Street 2:OFFICE 32
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3047
Practice Address - Country:US
Practice Address - Phone:317-316-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003708A101YM0800X
CA14743101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health