Provider Demographics
NPI:1942490222
Name:JOHNSON, GARY ALLEN (LPC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ALLEN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 DUVALL DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-8026
Mailing Address - Country:US
Mailing Address - Phone:325-227-2871
Mailing Address - Fax:
Practice Address - Street 1:3304 TERRACE AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-5819
Practice Address - Country:US
Practice Address - Phone:432-940-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13176101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional