Provider Demographics
NPI:1386306116
Name:JUNKO JOHNSON MARRIAGE & FAMILY THERAPY PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JUNKO JOHNSON MARRIAGE & FAMILY THERAPY PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUNKO
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:949-432-6693
Mailing Address - Street 1:11 ARBORSIDE WAY
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-5950
Mailing Address - Country:US
Mailing Address - Phone:949-413-3350
Mailing Address - Fax:949-298-3969
Practice Address - Street 1:25255 CABOT RD STE 228
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5529
Practice Address - Country:US
Practice Address - Phone:949-432-6693
Practice Address - Fax:949-298-3969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health