Provider Demographics
NPI:1063585784
Name:JOHNSON, MICHAEL DEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DEAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14740 BARRYKNOLL LN
Mailing Address - Street 2:SUITE 130
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2884
Mailing Address - Country:US
Mailing Address - Phone:281-679-0333
Mailing Address - Fax:281-679-6545
Practice Address - Street 1:14740 BARRYKNOLL LN
Practice Address - Street 2:SUITE 130
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079
Practice Address - Country:US
Practice Address - Phone:281-679-0333
Practice Address - Fax:281-679-6545
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30562103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149851101Medicaid
TX0004GDOtherBLUE CROSS
TX231238OtherVALUE OPTIONS