Provider Demographics
NPI:1417592171
Name:JOHNSON, ANNE KATHLEEN
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:KATHLEEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14837 IRONDALE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4585
Mailing Address - Country:US
Mailing Address - Phone:512-729-1979
Mailing Address - Fax:
Practice Address - Street 1:9501 N CAPITAL OF TEXAS HWY STE 301
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-6374
Practice Address - Country:US
Practice Address - Phone:512-729-1979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-16
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82652102L00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst