Provider Demographics
NPI:1801923529
Name:JOHNSON, KATHLEEN PATRICIA
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:PATRICIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:PATRICIA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6 LA MEDIA DR
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-3512
Mailing Address - Country:US
Mailing Address - Phone:530-534-1715
Mailing Address - Fax:
Practice Address - Street 1:6 LA MEDIA DR
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-3512
Practice Address - Country:US
Practice Address - Phone:530-534-1715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health