Provider Demographics
NPI:1912860495
Name:JOHNSON JR, WILLIAM
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:JOHNSON JR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 REPUBLIC PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6902
Mailing Address - Country:US
Mailing Address - Phone:214-817-2457
Mailing Address - Fax:214-393-5875
Practice Address - Street 1:1675 REPUBLIC PKWY STE 104
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6902
Practice Address - Country:US
Practice Address - Phone:214-817-2457
Practice Address - Fax:214-393-5875
Is Sole Proprietor?:No
Enumeration Date:2025-12-03
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician