Provider Demographics
NPI:1639331457
Name:JOHNSON, ANDREA MICHELLE (MED, LPC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MICHELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 W ROYAL LN
Mailing Address - Street 2:SUITE 271
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2516
Mailing Address - Country:US
Mailing Address - Phone:214-492-1975
Mailing Address - Fax:214-492-1935
Practice Address - Street 1:5005 W ROYAL LN
Practice Address - Street 2:SUITE 271
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2516
Practice Address - Country:US
Practice Address - Phone:214-492-1975
Practice Address - Fax:214-492-1935
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62229101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional