Provider Demographics
NPI:1336214964
Name:JOHNSON, ELAINE FAYE (LPC)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:FAYE
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 1:1905 PLYMOUTH ROCK DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-3944
Mailing Address - Country:US
Mailing Address - Phone:972-690-0305
Mailing Address - Fax:972-690-0305
Practice Address - Street 1:801 W. AVE. D
Practice Address - Street 2:FIRST BAPTIST CHURCH
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-7097
Practice Address - Country:US
Practice Address - Phone:972-276-7194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17103101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6421 LCOtherBCBSTX