Provider Demographics
NPI:1194069849
Name:JOHNSON, KATHRYN ELISE (LPC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 S COOPER ST STE 9
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-6718
Mailing Address - Country:US
Mailing Address - Phone:817-988-9635
Mailing Address - Fax:817-549-9993
Practice Address - Street 1:7100 S COOPER ST STE 9
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001
Practice Address - Country:US
Practice Address - Phone:817-988-9635
Practice Address - Fax:817-549-9993
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332831101YM0800X
TX67808101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3212011-01Medicaid