Provider Demographics
NPI:1326668518
Name:JOHNSON, BRYCE ANTHONY (AMFT)
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:ANTHONY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1666 RAMONA AVE
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-2203
Mailing Address - Country:US
Mailing Address - Phone:805-474-7060
Mailing Address - Fax:
Practice Address - Street 1:1666 RAMONA AVE
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2203
Practice Address - Country:US
Practice Address - Phone:805-473-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CAAMFT127365106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist