Provider Demographics
NPI:1346566932
Name:JOHNSON, PHILLIP II (LPC)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:JOHNSON
Suffix:II
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4522 FREDERICKSBURG RD
Mailing Address - Street 2:SUITE A-45
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-6521
Mailing Address - Country:US
Mailing Address - Phone:210-716-5040
Mailing Address - Fax:866-716-3426
Practice Address - Street 1:4522 FREDERICKSBURG RD
Practice Address - Street 2:SUITE A-45
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-6521
Practice Address - Country:US
Practice Address - Phone:210-716-5040
Practice Address - Fax:866-716-3426
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63494101YP2500X
TX10788101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)