Provider Demographics
NPI:1417833153
Name:JOHNSON, TREVOR (CWCII)
Entity type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:CWCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8695 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-9511
Mailing Address - Country:US
Mailing Address - Phone:707-837-7767
Mailing Address - Fax:
Practice Address - Street 1:8695 WINDSOR RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-9511
Practice Address - Country:US
Practice Address - Phone:707-837-7767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4D2655479E171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach