Provider Demographics
NPI:1487805917
Name:JOHNSON, NANCY L III (MS, LPC/MHSP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:JOHNSON
Suffix:III
Gender:F
Credentials:MS, LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:691 WHITTENBURG DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-1637
Mailing Address - Country:US
Mailing Address - Phone:901-830-5140
Mailing Address - Fax:
Practice Address - Street 1:691 WHITTENBURG DR
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-1637
Practice Address - Country:US
Practice Address - Phone:901-830-5140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000000857101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional