Provider Demographics
NPI:1720124928
Name:JOHNSON, KEVEL IVONDA (MS, MFTI)
Entity type:Individual
Prefix:MS
First Name:KEVEL
Middle Name:IVONDA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5352 COVEY RUN CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-7453
Mailing Address - Country:US
Mailing Address - Phone:559-903-7151
Mailing Address - Fax:
Practice Address - Street 1:1470 W HERNDON AVE
Practice Address - Street 2:#300
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-0552
Practice Address - Country:US
Practice Address - Phone:559-256-2000
Practice Address - Fax:559-256-3000
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI1143106H00000X
CA1143106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist