Provider Demographics
NPI:1336944933
Name:JOHNSON, MARKETA (LCSW)
Entity type:Individual
Prefix:
First Name:MARKETA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4617 LEMON TREE LN
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-2116
Mailing Address - Country:US
Mailing Address - Phone:940-315-3125
Mailing Address - Fax:
Practice Address - Street 1:4617 LEMON TREE LN
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-2116
Practice Address - Country:US
Practice Address - Phone:940-315-3125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15219101YA0400X
TX104658101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)