Provider Demographics
NPI:1801834031
Name:JOHNSON, PAUL ARTHUR (MA, LPC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ARTHUR
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 BROADMOOR DR
Mailing Address - Street 2:SUITEA-103
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2847
Mailing Address - Country:US
Mailing Address - Phone:979-846-3778
Mailing Address - Fax:979-774-0606
Practice Address - Street 1:2402 BROADMOOR DR
Practice Address - Street 2:SUITE A-103
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2847
Practice Address - Country:US
Practice Address - Phone:979-846-3778
Practice Address - Fax:979-774-0606
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13843101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX027335101Medicaid