Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TC2200X | Clinical Child & Adolescent Psychologist | ||
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY32738 | CA |
NPI | 1003103268 |
---|---|
Provider Name | Lori Johnson |
First Address | Irvine, CA 92623-7834 |
Second Address | Irvine, CA 92618-3837 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2011 |
Last Update Date | 26/08/2021 |