Provider Demographics
NPI:1104326966
Name:JOHNSON, CARIN M (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:CARIN
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 ROGERS RD APT 265
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-8616
Mailing Address - Country:US
Mailing Address - Phone:817-992-0709
Mailing Address - Fax:
Practice Address - Street 1:1717 W PLANO PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8618
Practice Address - Country:US
Practice Address - Phone:214-618-7985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4446103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst