Provider Demographics
NPI:1285349811
Name:JOHNSON, TAMARA LYNNE (LPC)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:LYNNE
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 1:17604 WINDFLOWER WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5318
Mailing Address - Country:US
Mailing Address - Phone:214-725-4676
Mailing Address - Fax:
Practice Address - Street 1:6101 W PLANO PKWY STE 240
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8373
Practice Address - Country:US
Practice Address - Phone:469-613-3390
Practice Address - Fax:469-613-3335
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17670101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional