Provider Demographics
NPI:1932670940
Name:JOHNSON, ELLEN ROSE (LPC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:ROSE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15100 ELLA BLVD APT 1109
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-7035
Mailing Address - Country:US
Mailing Address - Phone:320-360-7496
Mailing Address - Fax:
Practice Address - Street 1:5909 WEST LOOP S STE 640
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2430
Practice Address - Country:US
Practice Address - Phone:346-320-3195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77739101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health