Provider Demographics
NPI:1144239963
Name:JOHNSON, F LANE (MDIV, LPC)
Entity Type:Individual
Prefix:MR
First Name:F
Middle Name:LANE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MDIV, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 PATTERSON DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5645
Mailing Address - Country:US
Mailing Address - Phone:361-575-5021
Mailing Address - Fax:361-575-0623
Practice Address - Street 1:2003 PATTERSON DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5645
Practice Address - Country:US
Practice Address - Phone:361-575-5021
Practice Address - Fax:361-575-0623
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7861101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80415LOtherBLUECROSSBLUESHIELD
TX4315123OtherAETNA