Provider Demographics
NPI:1285774448
Name:JOHNSON, PATTI LEE (LICENSED CLINICAL PS)
Entity type:Individual
Prefix:DR
First Name:PATTI
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LICENSED CLINICAL PS
Other - Prefix:
Other - First Name:PATTI
Other - Middle Name:LEE
Other - Last Name:SIGL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:15300 VENTURA BLVD.
Mailing Address - Street 2:SUITE 502
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403
Mailing Address - Country:US
Mailing Address - Phone:818-522-2941
Mailing Address - Fax:818-501-6352
Practice Address - Street 1:15300 VENTURA BLVD.
Practice Address - Street 2:SUITE 502
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:818-522-2941
Practice Address - Fax:818-501-6352
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23520103T00000X
VA0810003568103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical