Provider Demographics
NPI:1750915963
Name:K JOHNSON ENTERPRISES LLC
Entity type:Organization
Organization Name:K JOHNSON ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:Y. DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCDC
Authorized Official - Phone:512-910-5188
Mailing Address - Street 1:PO BOX 144031
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78714-4031
Mailing Address - Country:US
Mailing Address - Phone:512-910-5188
Mailing Address - Fax:
Practice Address - Street 1:7901 CAMERON RD STE 2-139
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-3802
Practice Address - Country:US
Practice Address - Phone:512-910-5188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:K JOHNSON ENTERPRISES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty