Provider Demographics
NPI:1003468661
Name:JOHNSON, TAMYRA DANICA (PSYD)
Entity type:Individual
Prefix:
First Name:TAMYRA
Middle Name:DANICA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 HEDGCOXE RD
Mailing Address - Street 2:P.O. BOX 250086
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-0818
Mailing Address - Country:US
Mailing Address - Phone:469-209-5983
Mailing Address - Fax:
Practice Address - Street 1:1340 PRUDENTIAL DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-4115
Practice Address - Country:US
Practice Address - Phone:469-458-0106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-14
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40448103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical