Provider Demographics
NPI:1962555946
Name:JOHNSON, RAYMOND JR (MED)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15423 SILVER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-4207
Mailing Address - Country:US
Mailing Address - Phone:281-583-1719
Mailing Address - Fax:281-583-1768
Practice Address - Street 1:15423 SILVER RIDGE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-4207
Practice Address - Country:US
Practice Address - Phone:281-583-1719
Practice Address - Fax:281-583-1768
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX08290101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional