Basic Information
| Provider Information | |||||||||
| NPI: | 1629101563 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHANNSEN-ELBLING | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | M | ||||||||
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| OtherOrganizationName: | |||||||||
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| OtherLastName: | JOHANNSEN | ||||||||
| OtherFirstName: | CHRISTINA | ||||||||
| OtherMiddleName: | M. | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 15750 HILLGATE DR | ||||||||
| Address2: | |||||||||
| City: | LA MIRADA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906381516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629023849 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9140 WHITTIER BLVD | ||||||||
| Address2: | |||||||||
| City: | PICO RIVERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906602444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628014626 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | IMF51352 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.