Provider Demographics
NPI:1558939181
Name:JOHNSON, JENNIE RAE (LCDC, LPC-ASSOCIATE)
Entity Type:Individual
Prefix:MISS
First Name:JENNIE
Middle Name:RAE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCDC, LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 GULFTON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-1107
Mailing Address - Country:US
Mailing Address - Phone:713-457-4372
Mailing Address - Fax:
Practice Address - Street 1:6315 GULFTON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-1107
Practice Address - Country:US
Practice Address - Phone:713-457-4372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15566101YA0400X
TX85171101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)