Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PSY26234 | CA |
NPI | 1053909374 |
---|---|
Provider Name | Dr. Colleen Anne Johnson |
First Address | Campbell, CA 95008-1535 |
Second Address | Campbell, CA 95008-1847 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2021 |
Last Update Date | 03/01/2021 |