Provider Demographics
NPI:1942626684
Name:JOHNSON-TAYLOR, CASIE (LMFT)
Entity Type:Individual
Prefix:
First Name:CASIE
Middle Name:
Last Name:JOHNSON-TAYLOR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CASIE
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:5173 WARING RD # 457
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2705
Mailing Address - Country:US
Mailing Address - Phone:619-736-0363
Mailing Address - Fax:
Practice Address - Street 1:5173 WARING RD # 457
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2705
Practice Address - Country:US
Practice Address - Phone:619-736-0363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86292106H00000X
CA69109106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist