Provider Demographics
NPI:1295330710
Name:JOHNSON, TARYN C (MFT)
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:C
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13374 ARMITSTEAD CIR
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-8704
Mailing Address - Country:US
Mailing Address - Phone:209-483-3922
Mailing Address - Fax:
Practice Address - Street 1:400 CAPITOL MALL FL 8
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-4430
Practice Address - Country:US
Practice Address - Phone:916-852-5662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98107106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist