Provider Demographics
NPI:1710334396
Name:JOHNSON, RUBY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RUBY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 REGAL RD
Mailing Address - Street 2:SUITE 104C
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6315
Mailing Address - Country:US
Mailing Address - Phone:469-708-6387
Mailing Address - Fax:972-767-3234
Practice Address - Street 1:2801 REGAL RD
Practice Address - Street 2:SUITE 104C
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6315
Practice Address - Country:US
Practice Address - Phone:469-708-6387
Practice Address - Fax:972-767-3234
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX396401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical