Provider Demographics
NPI:1699176305
Name:JOHNSON, MIRNA (BS (LMFT))
Entity Type:Individual
Prefix:
First Name:MIRNA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BS (LMFT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 N ARROWHEAD AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-1016
Mailing Address - Country:US
Mailing Address - Phone:909-361-1546
Mailing Address - Fax:909-361-1546
Practice Address - Street 1:141 N ARROWHEAD AVE STE 5
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-1016
Practice Address - Country:US
Practice Address - Phone:909-361-1546
Practice Address - Fax:909-361-1546
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT124973106H00000X
CAIMF91851101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health