Provider Demographics
NPI:1811755754
Name:JOHNSON MITCHELL, KAREN LOUISE (ACSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LOUISE
Last Name:JOHNSON MITCHELL
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LOUISE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4316 EDENHURST AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1263
Mailing Address - Country:US
Mailing Address - Phone:323-642-4762
Mailing Address - Fax:
Practice Address - Street 1:1625 W OLYMPIC BLVD STE 603
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3809
Practice Address - Country:US
Practice Address - Phone:323-642-4762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1166171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical