Provider Demographics
NPI:1740422484
Name:JOHNSON, SHERRY ANN (MFT)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:ANN
Other - Last Name:KEECH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:1200 FRANKLIN MALL UNIT 293
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95052-6012
Mailing Address - Country:US
Mailing Address - Phone:408-510-4848
Mailing Address - Fax:408-244-2491
Practice Address - Street 1:1200 FRANKLIN MALL UNIT 293
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95052-6012
Practice Address - Country:US
Practice Address - Phone:408-510-4848
Practice Address - Fax:408-244-2491
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36912106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist