Provider Demographics
NPI:1104285626
Name:JOHNSON, GISSELLE PADILLA (MFTI-93202)
Entity type:Individual
Prefix:
First Name:GISSELLE
Middle Name:PADILLA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MFTI-93202
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9057 SOQUEL DRIVE C, SUITE A
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4001
Mailing Address - Country:US
Mailing Address - Phone:831-662-1303
Mailing Address - Fax:831-662-1317
Practice Address - Street 1:9057 SOQUEL DRIVE C, SUITE A
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4001
Practice Address - Country:US
Practice Address - Phone:831-662-1303
Practice Address - Fax:831-662-1317
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health