Provider Demographics
NPI:1073919767
Name:JOHNSON, JESSICA FRANKS (LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:FRANKS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328H JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-7014
Mailing Address - Country:US
Mailing Address - Phone:337-849-3736
Mailing Address - Fax:
Practice Address - Street 1:328 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-4923
Practice Address - Country:US
Practice Address - Phone:337-332-2844
Practice Address - Fax:337-332-5458
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4417101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional