Provider Demographics
NPI:1821639089
Name:JOHNSON, WENDI LEIGH (PHD)
Entity Type:Individual
Prefix:DR
First Name:WENDI
Middle Name:LEIGH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 STOWE LN
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75068-4387
Mailing Address - Country:US
Mailing Address - Phone:940-783-0399
Mailing Address - Fax:
Practice Address - Street 1:490 S I 35 E
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7768
Practice Address - Country:US
Practice Address - Phone:940-783-0399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33131103TS0200X
TX34292103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool