Provider Demographics
NPI:1205994282
Name:JOHNSON, STEPHEN WESLEY (PHD, LPC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WESLEY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12636 SETTING SUN DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4652
Mailing Address - Country:US
Mailing Address - Phone:915-355-9137
Mailing Address - Fax:
Practice Address - Street 1:12636 SETTING SUN DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-4652
Practice Address - Country:US
Practice Address - Phone:915-355-9137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10253101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor