Provider Demographics
NPI:1598235327
Name:JOHNSON, TONIA DEVETT
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:DEVETT
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 FARRAH LN APT 1221
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-6051
Mailing Address - Country:US
Mailing Address - Phone:713-594-3738
Mailing Address - Fax:
Practice Address - Street 1:1000 FARRAH LN APT 1221
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-6051
Practice Address - Country:US
Practice Address - Phone:713-594-3738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral