Provider Demographics
NPI:1568536381
Name:JOHNSON, SHANNON LYNNE (LPC)
Entity Type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:LYNNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 JESTER PL
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-2224
Mailing Address - Country:US
Mailing Address - Phone:972-824-0803
Mailing Address - Fax:972-968-5210
Practice Address - Street 1:9555 LEBANON RD
Practice Address - Street 2:903
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-6080
Practice Address - Country:US
Practice Address - Phone:972-824-0803
Practice Address - Fax:469-362-7330
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12095101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health