Provider Demographics
NPI:1043828494
Name:JOHNSON, SYDNEY SIMONE (LMFT 142306)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:SIMONE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMFT 142306
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10578 DEER CANYON DR
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-2478
Mailing Address - Country:US
Mailing Address - Phone:909-689-7241
Mailing Address - Fax:
Practice Address - Street 1:8605 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-4109
Practice Address - Country:US
Practice Address - Phone:909-689-7241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120018106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist