Provider Demographics
NPI:1851796254
Name:JOHNSON, KATHY (MHRS)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2603
Mailing Address - Country:US
Mailing Address - Phone:415-777-0333
Mailing Address - Fax:415-864-4042
Practice Address - Street 1:921 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-2210
Practice Address - Country:US
Practice Address - Phone:415-664-1414
Practice Address - Fax:415-664-7741
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X, 101YM0800X, 171M00000X
CAR1289390218101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator