Provider Demographics
NPI:1366000929
Name:JOHNSON, DUANE (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 REDWOOD LODGE DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2430
Mailing Address - Country:US
Mailing Address - Phone:254-317-2883
Mailing Address - Fax:
Practice Address - Street 1:800 ROCKMEAD DR STE 155
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2652
Practice Address - Country:US
Practice Address - Phone:281-631-5229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78301101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional