Provider Demographics
NPI:1023815826
Name:WALTON, JOHANNAH GRACE (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHANNAH
Middle Name:GRACE
Last Name:WALTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 HAZELTINE AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-6406
Mailing Address - Country:US
Mailing Address - Phone:714-402-2068
Mailing Address - Fax:
Practice Address - Street 1:5008 HAZELTINE AVE APT 12
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-6406
Practice Address - Country:US
Practice Address - Phone:714-402-2068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35609103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty