Provider Demographics
NPI:1720124928
Name:JOHNSON, KEVEL IVONDA (MS, MFTI)
Entity Type:Individual
Prefix:MS
First Name:KEVEL
Middle Name:IVONDA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10224 N RECREATION AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-4738
Mailing Address - Country:US
Mailing Address - Phone:559-434-5532
Mailing Address - Fax:
Practice Address - Street 1:1470 W HERNDON AVE
Practice Address - Street 2:#300
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-0552
Practice Address - Country:US
Practice Address - Phone:559-256-2000
Practice Address - Fax:559-256-3000
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50218106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist