Provider Demographics
NPI:1710369202
Name:JOHNSON, ANA GABRIELA (LMFT)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:GABRIELA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 S STONE BENCH RD
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-2792
Mailing Address - Country:US
Mailing Address - Phone:520-603-7845
Mailing Address - Fax:
Practice Address - Street 1:561 S STONE BENCH RD
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-2792
Practice Address - Country:US
Practice Address - Phone:520-603-7845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16010106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist