Provider Demographics
NPI:1508144940
Name:JOHNSON, KEISHA HOLLEY (PHD)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:HOLLEY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KEISHA
Other - Middle Name:LANETTE
Other - Last Name:HOLLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:11201 RICHMOND AVE STE A-111A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-6653
Mailing Address - Country:US
Mailing Address - Phone:281-512-4734
Mailing Address - Fax:281-293-8100
Practice Address - Street 1:11201 RICHMOND AVE
Practice Address - Street 2:SUITE A-111A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-6653
Practice Address - Country:US
Practice Address - Phone:281-512-4734
Practice Address - Fax:281-293-8100
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35188103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist