Provider Demographics
NPI:1417329905
Name:JOHNSON, ALAN EDWARD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:EDWARD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 BALCONES DR STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4298
Mailing Address - Country:US
Mailing Address - Phone:214-945-2727
Mailing Address - Fax:972-449-7075
Practice Address - Street 1:4100 SPRING VALLEY RD STE 910
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-3646
Practice Address - Country:US
Practice Address - Phone:214-945-2727
Practice Address - Fax:972-449-7075
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37103103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist