Provider Demographics
NPI:1063999175
Name:JOHNSON, CLAYTON JAMES (MA, LMFT, DIR)
Entity type:Individual
Prefix:MR
First Name:CLAYTON
Middle Name:JAMES
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MA, LMFT, DIR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 N GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-2828
Mailing Address - Country:US
Mailing Address - Phone:818-848-8825
Mailing Address - Fax:818-848-8815
Practice Address - Street 1:2101 N GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-2828
Practice Address - Country:US
Practice Address - Phone:818-848-8825
Practice Address - Fax:818-848-8815
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-21
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107668106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist