Provider Demographics
NPI:1063044402
Name:JOHNSON, LYNSI AUTUMN
Entity Type:Individual
Prefix:
First Name:LYNSI
Middle Name:AUTUMN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNSI
Other - Middle Name:AUTUMN
Other - Last Name:MAURER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3549 CEDAR RUN RD APT 1506
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-2469
Mailing Address - Country:US
Mailing Address - Phone:325-280-1580
Mailing Address - Fax:
Practice Address - Street 1:3549 CEDAR RUN RD APT 1506
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-2469
Practice Address - Country:US
Practice Address - Phone:325-280-1580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician