Provider Demographics
NPI:1780716332
Name:PRECIADO, JOHANNE ALEXANDRA
Entity type:Individual
Prefix:
First Name:JOHANNE
Middle Name:ALEXANDRA
Last Name:PRECIADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOHANNE
Other - Middle Name:ALEXANDRA
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4760 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4820
Mailing Address - Country:US
Mailing Address - Phone:310-390-6612
Mailing Address - Fax:310-398-5690
Practice Address - Street 1:221 N ARDMORE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-4503
Practice Address - Country:US
Practice Address - Phone:213-381-3626
Practice Address - Fax:213-380-8923
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2148101YP2500X
CAMFC 45443106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional