Provider Demographics
NPI:1659558393
Name:JOHNSON, TYNE JENINE (CAARR)
Entity Type:Individual
Prefix:
First Name:TYNE
Middle Name:JENINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CAARR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N STATE ST
Mailing Address - Street 2:SUITE 'A'
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-1485
Mailing Address - Country:US
Mailing Address - Phone:951-929-9838
Mailing Address - Fax:951-929-9831
Practice Address - Street 1:950 N STATE ST
Practice Address - Street 2:SUITE 'A'
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-1485
Practice Address - Country:US
Practice Address - Phone:951-929-9838
Practice Address - Fax:951-929-9831
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)