Provider Demographics
NPI:1912685769
Name:JOHNSON, LEXIS (BA)
Entity type:Individual
Prefix:
First Name:LEXIS
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 HUDSON LN STE 15
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6054
Mailing Address - Country:US
Mailing Address - Phone:318-309-1862
Mailing Address - Fax:225-308-8359
Practice Address - Street 1:1300 HUDSON LN STE 15
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6054
Practice Address - Country:US
Practice Address - Phone:318-309-1862
Practice Address - Fax:225-308-8359
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional