MEDICARE: CELESTE EVE JOHNSON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	60557	TX

General Provider Information

NPI Number	:	1366659534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELESTE EVE JOHNSON LPC

Provider Business Mailing Address
First Line	:	18123 FERNBLUFF DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-4036
Country	:	US
Telephone Number	:	210-273-9066
Fax Number	:

Provider Business Practice Location Address
First Line	:	3630 W DALLAS ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-1704
Country	:	US
Telephone Number	:	713-970-4450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	06/18/2009

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