Provider Demographics
NPI:1912204223
Name:JOHNSON, RENEE MARIE (LMFTA)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4324 A ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-7722
Mailing Address - Country:US
Mailing Address - Phone:360-888-2688
Mailing Address - Fax:
Practice Address - Street 1:4324 A ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-7722
Practice Address - Country:US
Practice Address - Phone:360-888-2688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60161718106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist