Healthcare Provider Details

I. General information

NPI: 1194199208
Provider Name (Legal Business Name): CHESTER E JOHNSON JR. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82O JORDAN ST SUITE 510A
SHREVEPORT LA
71101
US

IV. Provider business mailing address

5900 VALLEYBROOK DR
PLANO TX
75093-7738
US

V. Phone/Fax

Practice location:
  • Phone: 318-861-1090
  • Fax:
Mailing address:
  • Phone: 585-261-2369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7635
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number96952
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number96952
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: