1386306116 NPI number — JUNKO JOHNSON MARRIAGE & FAMILY THERAPY PROFESSIONAL CORPORATION

Table of content: (NPI 1386306116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386306116 NPI number — JUNKO JOHNSON MARRIAGE & FAMILY THERAPY PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUNKO JOHNSON MARRIAGE & FAMILY THERAPY PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386306116
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 ARBORSIDE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSION VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92692-5950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-413-3350
Provider Business Mailing Address Fax Number:
949-298-3969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25255 CABOT RD STE 228
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGUNA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92653-5529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-432-6693
Provider Business Practice Location Address Fax Number:
949-298-3969
Provider Enumeration Date:
10/08/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
JUNKO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
949-432-6693

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)