Provider Demographics
NPI:1740310887
Name:JOHNSON, ERIC (MS, LMFT)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FORDYCE
Mailing Address - State:AR
Mailing Address - Zip Code:71742-3014
Mailing Address - Country:US
Mailing Address - Phone:870-352-5122
Mailing Address - Fax:870-352-5127
Practice Address - Street 1:1101 W 3RD ST
Practice Address - Street 2:
Practice Address - City:FORDYCE
Practice Address - State:AR
Practice Address - Zip Code:71742-3014
Practice Address - Country:US
Practice Address - Phone:870-352-5122
Practice Address - Fax:870-352-5127
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0609064101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional