Provider Demographics
NPI:1972021996
Name:JOHNSON-GIERTH, ALLISON MOORE (MA, LMFT, LPCC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MOORE
Last Name:JOHNSON-GIERTH
Suffix:
Gender:F
Credentials:MA, LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 SUNRISE AVENUE STE B 195
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661
Mailing Address - Country:US
Mailing Address - Phone:916-770-5506
Mailing Address - Fax:
Practice Address - Street 1:2412 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7773
Practice Address - Country:US
Practice Address - Phone:916-770-5506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115803106H00000X
CAIMF101421106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist