Provider Demographics
NPI:1548578248
Name:JOHNSON, TIMOTHY LEROY (MA, MFT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LEROY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8322
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-8322
Mailing Address - Country:US
Mailing Address - Phone:702-286-2754
Mailing Address - Fax:
Practice Address - Street 1:1130 12TH ST STE A
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-0834
Practice Address - Country:US
Practice Address - Phone:209-918-5466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 53853106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist