Provider Demographics
NPI:1760739056
Name:JOHNSON, RAYLENE ELAINE (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:RAYLENE
Middle Name:ELAINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:RAYLENE
Other - Middle Name:ELAINE
Other - Last Name:ANGULO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:271 E WORKMAN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3547
Mailing Address - Country:US
Mailing Address - Phone:626-331-0335
Mailing Address - Fax:626-331-0339
Practice Address - Street 1:271 E. WORKMAN ST, SUITE 101
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723
Practice Address - Country:US
Practice Address - Phone:626-331-0335
Practice Address - Fax:626-331-0339
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT106553106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist