Provider Demographics
NPI:1891842084
Name:JOHNSON, FRITZ ROY (MFT)
Entity Type:Individual
Prefix:MR
First Name:FRITZ
Middle Name:ROY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 2ND ST STE 1
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4656
Mailing Address - Country:US
Mailing Address - Phone:530-758-2489
Mailing Address - Fax:530-297-1749
Practice Address - Street 1:719 2ND ST STE 1
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4656
Practice Address - Country:US
Practice Address - Phone:530-758-2489
Practice Address - Fax:530-297-1749
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37246106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist