Healthcare Provider Details

I. General information

NPI: 1770302903
Provider Name (Legal Business Name): LUCIANA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 N WESTMORELAND RD
DALLAS TX
75211-1654
US

IV. Provider business mailing address

1350 N WESTMORELAND RD
DALLAS TX
75211-1654
US

V. Phone/Fax

Practice location:
  • Phone: 469-766-5715
  • Fax:
Mailing address:
  • Phone: 469-766-5715
  • Fax: 214-330-2439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number89503
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: