Provider Demographics
NPI:1205450327
Name:JOHNSON, TIAWNA ROSE (LPC)
Entity type:Individual
Prefix:
First Name:TIAWNA
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 1:8176 FLINTSTONE TRL APT 303
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-2473
Mailing Address - Country:US
Mailing Address - Phone:417-274-8923
Mailing Address - Fax:
Practice Address - Street 1:1945 LAKEPOINTE DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-6469
Practice Address - Country:US
Practice Address - Phone:888-688-9296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional