Provider Demographics
NPI:1255916219
Name:JOHNSON, MELINDA KAY (LPC)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:KAY
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 1:6535 DAISY
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-6878
Mailing Address - Country:US
Mailing Address - Phone:409-550-1969
Mailing Address - Fax:
Practice Address - Street 1:7980 ANCHOR DR STE 500
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8285
Practice Address - Country:US
Practice Address - Phone:409-727-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79401101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional