Provider Demographics
NPI:1760810345
Name:JOHNSON, WILLIAM THOMAS JOSHUA (PHD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:THOMAS JOSHUA
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:W.
Other - Middle Name:JOSHUA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:17315 STUDEBAKER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2565
Mailing Address - Country:US
Mailing Address - Phone:562-999-4707
Mailing Address - Fax:877-741-9754
Practice Address - Street 1:17315 STUDEBAKER RD STE 105
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2565
Practice Address - Country:US
Practice Address - Phone:562-999-4707
Practice Address - Fax:877-741-9754
Is Sole Proprietor?:No
Enumeration Date:2013-10-17
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25976103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical