Provider Demographics
NPI:1215725965
Name:JOHNSON, MIREYA CRYSTAL (MA, BCBA)
Entity type:Individual
Prefix:
First Name:MIREYA
Middle Name:CRYSTAL
Last Name:JOHNSON
Suffix:
Gender:
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6914 BRISBANE CT STE 200
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4924
Mailing Address - Country:US
Mailing Address - Phone:844-272-7223
Mailing Address - Fax:
Practice Address - Street 1:1620 FM 544 STE 100
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-7084
Practice Address - Country:US
Practice Address - Phone:844-272-7223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8387103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst