Provider Demographics
NPI:1710265178
Name:JOHNSON, PAMELA (LPC)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:
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 1:5425 N GARLAND AVE
Mailing Address - Street 2:SUITE 140, PMB-201
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-2718
Mailing Address - Country:US
Mailing Address - Phone:972-494-9497
Mailing Address - Fax:972-487-1629
Practice Address - Street 1:5425 N GARLAND AVE
Practice Address - Street 2:SUITE 140, PMB-201
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-2718
Practice Address - Country:US
Practice Address - Phone:972-494-9497
Practice Address - Fax:972-487-1629
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13083101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional