Provider Demographics
NPI:1780728196
Name:JOHNSON, SUSAN ELIZABETH (MFT)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1167 ENGLEWILD DR
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-2286
Mailing Address - Country:US
Mailing Address - Phone:626-963-5623
Mailing Address - Fax:626-963-8493
Practice Address - Street 1:521 S MYRTLE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2813
Practice Address - Country:US
Practice Address - Phone:626-963-5623
Practice Address - Fax:626-963-8493
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC8464101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health