Provider Demographics
NPI:1861671562
Name:COUNTS, JOHNNY LEE (LCDC)
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:LEE
Last Name:COUNTS
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 RICHMOND RD
Mailing Address - Street 2:#122
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-5100
Mailing Address - Country:US
Mailing Address - Phone:903-334-9067
Mailing Address - Fax:903-334-9067
Practice Address - Street 1:2815 RICHMOND RD
Practice Address - Street 2:#122
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-5100
Practice Address - Country:US
Practice Address - Phone:903-334-9067
Practice Address - Fax:903-334-9067
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9491101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)