Provider Demographics
NPI:1194294546
Name:JOHNSON, ALLEN KEITH JR (DPC, LPC-S)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:KEITH
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:DPC, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 W. GOVERNMENT STREET, BUILDING B.
Mailing Address - Street 2:SUITE 214
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042
Mailing Address - Country:US
Mailing Address - Phone:601-613-1240
Mailing Address - Fax:
Practice Address - Street 1:1700 WEST GOVERNMENT STREET BUILDING B. SUITE O.
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042
Practice Address - Country:US
Practice Address - Phone:601-613-1240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS101YA0400X
MS1864101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty