Provider Demographics
NPI:1659756526
Name:JOHNSON, LAUREN VANESSA (MA ,LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:VANESSA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA ,LMFT
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Mailing Address - Street 1:9375 ARCHIBALD AVE SUITE 311
Mailing Address - Street 2:9375 ARCHIBALD AVE SUITE 311
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5703
Mailing Address - Country:US
Mailing Address - Phone:909-223-8684
Mailing Address - Fax:909-614-7521
Practice Address - Street 1:9375 ARCHIBALD AVE SUITE 311
Practice Address - Street 2:9375 ARCHIBALD AVE SUITE 311
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5703
Practice Address - Country:US
Practice Address - Phone:909-223-8684
Practice Address - Fax:909-614-7521
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2020-08-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA86811101Y00000X, 106H00000X
CALMFT86811106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor