Provider Demographics
NPI:1770387896
Name:JOHNSON-HEWITT, JESSICA SHANAY
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:SHANAY
Last Name:JOHNSON-HEWITT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15840 FM 529 RD STE 112
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-2565
Mailing Address - Country:US
Mailing Address - Phone:832-740-3058
Mailing Address - Fax:
Practice Address - Street 1:15840 FM 529 RD STE 112
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2565
Practice Address - Country:US
Practice Address - Phone:832-740-3058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92058101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health