Individual
MRS. ELLIE I JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
300 PRISON RD, REPRESA, CA 95671-0002
(916) 985-8610
Mailing address
PO BOX 290002, REPRESA, CA 95671-0002
(916) 985-8610
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY24135
CA
Other
Enumeration date
02/25/2010
Last updated
04/19/2013
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