Provider Demographics
NPI:1720307234
Name:JOHNSON, HEATHER (PHD, MA, MS)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD, MA, MS
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9815 CARROLL CANYON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1123
Mailing Address - Country:US
Mailing Address - Phone:858-863-6790
Mailing Address - Fax:
Practice Address - Street 1:9815 CARROLL CANYON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1123
Practice Address - Country:US
Practice Address - Phone:858-863-6790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health