Provider Demographics
NPI:1326241092
Name:JOHNSON, LAURA L (ATR-BC, LPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90576
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78709-0576
Mailing Address - Country:US
Mailing Address - Phone:512-762-5942
Mailing Address - Fax:
Practice Address - Street 1:4101 PARKSTONE HEIGHTS DR
Practice Address - Street 2:SUITE 260
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7396
Practice Address - Country:US
Practice Address - Phone:512-762-5942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2011-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14296101YM0800X
221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist