Provider Demographics
NPI:1558939181
Name:JOHNSON, JENNIE RAE (LCDC, LPC)
Entity type:Individual
Prefix:MISS
First Name:JENNIE
Middle Name:RAE
Last Name:JOHNSON
Suffix:
Gender:
Credentials:LCDC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15803 HEATHERDALE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-5918
Mailing Address - Country:US
Mailing Address - Phone:361-648-5404
Mailing Address - Fax:
Practice Address - Street 1:801 TRAVIS ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-5719
Practice Address - Country:US
Practice Address - Phone:361-648-5404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85171101YM0800X
TX15566101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)