Provider Demographics
NPI:1962508150
Name:JOHNSON, JEAN (LPC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5217 MACKENZIE WAY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4909
Mailing Address - Country:US
Mailing Address - Phone:972-381-1818
Mailing Address - Fax:972-250-4878
Practice Address - Street 1:5217 MACKENZIE WAY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4909
Practice Address - Country:US
Practice Address - Phone:972-381-1818
Practice Address - Fax:972-250-4878
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9857101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1122-0800OtherADDICTION COUNSELOR
TX721OtherMARRIAGE & FAMILY THERAPI