Provider Demographics
NPI:1962599985
Name:JOHNSON, RHONDA M (PHD)
Entity type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 MERCANTILE PLAZA DR
Mailing Address - Street 2:SUITE 307
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137
Mailing Address - Country:US
Mailing Address - Phone:817-268-6735
Mailing Address - Fax:817-284-2031
Practice Address - Street 1:4500 MERCANTILE PLAZA DR
Practice Address - Street 2:SUITE 307
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137
Practice Address - Country:US
Practice Address - Phone:817-268-6735
Practice Address - Fax:817-284-2031
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16860101Y00000X, 101YP2500X
TX5053106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3876625-01Medicaid