Provider Demographics
NPI:1366506537
Name:JOHNSON, PATRICIA DIANE (PSYD, MFT)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:DIANE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PSYD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 VENTURA BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3103
Mailing Address - Country:US
Mailing Address - Phone:818-725-2431
Mailing Address - Fax:323-669-0585
Practice Address - Street 1:15300 VENTURA BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3103
Practice Address - Country:US
Practice Address - Phone:818-725-2431
Practice Address - Fax:323-669-0585
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32475106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist