Provider Demographics
NPI:1851736177
Name:JOHNSON, DOUGLAS D (PSYCHOLOGICAL ASSIST)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PSYCHOLOGICAL ASSIST
Other - Prefix:DR
Other - First Name:DOUGLAS
Other - Middle Name:D
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYCHOLOGICAL ASSIST
Mailing Address - Street 1:39 LORINDA PL
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-3979
Mailing Address - Country:US
Mailing Address - Phone:805-453-5548
Mailing Address - Fax:
Practice Address - Street 1:2580 E MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2640
Practice Address - Country:US
Practice Address - Phone:805-402-3967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94025138103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical