Healthcare Provider Details

I. General information

NPI: 1326279472
Provider Name (Legal Business Name): STANLEY WILLARD JOHNSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 RIVERWOOD CT
CONROE TX
77304-2811
US

IV. Provider business mailing address

PO BOX 3067
CONROE TX
77305-3067
US

V. Phone/Fax

Practice location:
  • Phone: 936-756-8331
  • Fax: 936-760-2898
Mailing address:
  • Phone: 936-756-8331
  • Fax: 936-760-2898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number63540
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: