Provider Demographics
NPI:1376050641
Name:JOHNSON, NATALIE C (MS, LMFT-A, LCDC-I)
Entity Type:Individual
Prefix:MISS
First Name:NATALIE
Middle Name:C
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, LMFT-A, LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 COLE AVE APT 1416
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-5508
Mailing Address - Country:US
Mailing Address - Phone:682-738-5540
Mailing Address - Fax:
Practice Address - Street 1:4950 KELLER SPRINGS RD STE 310
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-6349
Practice Address - Country:US
Practice Address - Phone:682-738-5540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203108106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist