Provider Demographics
NPI:1699105387
Name:JOHNSON, KLOVER (LCSW)
Entity type:Individual
Prefix:
First Name:KLOVER
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5059 PRAIRIE FALCON CT
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3077
Mailing Address - Country:US
Mailing Address - Phone:484-663-0511
Mailing Address - Fax:484-663-0511
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:469-558-5867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical