Provider Demographics
NPI:1205062411
Name:JOHNSON, ALLISON (MA, MFT)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 APPLE ST STE A
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-4443
Mailing Address - Country:US
Mailing Address - Phone:760-439-4577
Mailing Address - Fax:760-439-2130
Practice Address - Street 1:3609 OCEAN RANCH BLVD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-2698
Practice Address - Country:US
Practice Address - Phone:760-418-4611
Practice Address - Fax:760-263-6164
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53936106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist