Provider Demographics
NPI:1881352326
Name:JOHNSON, STEPHANIE JILL (PH D, LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JILL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PH D, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8806 15TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-1924
Mailing Address - Country:US
Mailing Address - Phone:806-786-5449
Mailing Address - Fax:
Practice Address - Street 1:4601 50TH ST STE 208
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-3515
Practice Address - Country:US
Practice Address - Phone:806-786-5449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX282551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical