Provider Demographics
NPI:1568111086
Name:JOHNSON, SHERRY (LCDC)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 LOUIS HENNA BLVD APT 505
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7366
Mailing Address - Country:US
Mailing Address - Phone:512-966-9007
Mailing Address - Fax:
Practice Address - Street 1:1101 ARROW POINT DR STE 214
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7739
Practice Address - Country:US
Practice Address - Phone:512-966-9007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13506101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor