Provider Demographics
NPI:1841911229
Name:JOHNSON, JUDITH ALENE (PHD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ALENE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17506 STONEBELT DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-2770
Mailing Address - Country:US
Mailing Address - Phone:713-377-0307
Mailing Address - Fax:
Practice Address - Street 1:13810 CHAMPION FOREST DR STE 150
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-1883
Practice Address - Country:US
Practice Address - Phone:713-377-0307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32061103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist