Provider Demographics
NPI:1811355464
Name:JOHNSON, HEIDI RENEE (LMFT)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:RENEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:RENEE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 PALMA DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6451
Mailing Address - Country:US
Mailing Address - Phone:805-289-1500
Mailing Address - Fax:805-289-1511
Practice Address - Street 1:1500 PALMA DR
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6451
Practice Address - Country:US
Practice Address - Phone:805-289-1500
Practice Address - Fax:805-289-1511
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108676106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist