Provider Demographics
NPI:1861737876
Name:PERRI W JOHNSON, PSYCHOLOGY INC
Entity type:Organization
Organization Name:PERRI W JOHNSON, PSYCHOLOGY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRI JOHNSON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-762-5560
Mailing Address - Street 1:11331 VENTURA BLVD
Mailing Address - Street 2:1D
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3147
Mailing Address - Country:US
Mailing Address - Phone:818-762-5560
Mailing Address - Fax:818-762-7919
Practice Address - Street 1:11331 VENTURA BLVD
Practice Address - Street 2:1D
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3147
Practice Address - Country:US
Practice Address - Phone:818-762-5560
Practice Address - Fax:818-762-7919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-02
Last Update Date:2012-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14431103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty