Provider Demographics
NPI:1750614442
Name:JOHNSON, AUDREY SUE (MA, MS, PSYD)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:SUE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, MS, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23632 CALABASAS RD STE 103
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1724
Mailing Address - Country:US
Mailing Address - Phone:818-384-3115
Mailing Address - Fax:
Practice Address - Street 1:23632 CALABASAS RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1553
Practice Address - Country:US
Practice Address - Phone:818-384-3115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50181106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist