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NPI Code Detail

MEDICARE: EBONY JOHNSON BLUE LMHC

MEDICARE:   EBONY JOHNSON BLUE  LMHC
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
1101YM0800XMental Health Counselor11199-125WI
2101YP2500XProfessional Counselor70501TX
3101YM0800XMental Health CounselorLH61585624WA

General Provider Information

NPI Number : 1467839480
Entity Type Code : Individual
Provider Name (Legal Business Name) : EBONY JOHNSON BLUE LMHC
Provider Business Mailing Address
First Line : 2717 COMMERCIAL CENTER BLVD STE E200
Second Line :
City : KATY
State : TX
Zip : 77494-7823
Country : US
Telephone Number : 832-604-4390
Fax Number :
Provider Business Practice Location Address
First Line : 2717 COMMERCIAL CENTER BLVD STE E200
Second Line :
City : KATY
State : TX
Zip : 77494-7823
Country : US
Telephone Number : 832-604-4390
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2015
Last Update Date : 02/18/2025

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Directions to “ EBONY JOHNSON BLUE LMHC” Practice Location

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