Provider Demographics
NPI:1326188442
Name:JOHNSON, TODD RICHARD (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:RICHARD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5007 WING RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1629
Mailing Address - Country:US
Mailing Address - Phone:509-847-9951
Mailing Address - Fax:
Practice Address - Street 1:1600 PAYTON GIN RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-6506
Practice Address - Country:US
Practice Address - Phone:512-836-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71393101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional