Provider Demographics
NPI:1407867260
Name:BEENE, JOHNNIE MORRIS JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:JOHNNIE
Middle Name:MORRIS
Last Name:BEENE
Suffix:JR
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 1:5409 NEVADA DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-6105
Mailing Address - Country:US
Mailing Address - Phone:903-455-7449
Mailing Address - Fax:903-455-7449
Practice Address - Street 1:2410 LEE ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-4244
Practice Address - Country:US
Practice Address - Phone:903-455-7449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10364101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2072LCOtherBCBS OF TEXAS ID NUMBER