Provider Demographics
NPI:1508373796
Name:L J PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:L J PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR-S
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:469-600-5056
Mailing Address - Street 1:1011 TRACY AVE
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-3550
Mailing Address - Country:US
Mailing Address - Phone:469-600-5056
Mailing Address - Fax:972-863-3382
Practice Address - Street 1:515 N CEDAR RIDGE DR STE 7E
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-3179
Practice Address - Country:US
Practice Address - Phone:469-600-5056
Practice Address - Fax:972-863-3382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63935101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty