Healthcare Provider Details

I. General information

NPI: 1669166013
Provider Name (Legal Business Name): JOHNSON CHRISTIAN COUNSELING INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 E PIEDRAS DR STE 140
SAN ANTONIO TX
78228-1425
US

IV. Provider business mailing address

5118 GREEN CORAL
SAN ANTONIO TX
78223-4543
US

V. Phone/Fax

Practice location:
  • Phone: 210-719-0237
  • Fax: 210-547-0256
Mailing address:
  • Phone: 210-719-0237
  • Fax: 210-547-0256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. TRAVIS JOHNSON SR.
Title or Position: OWNER
Credential: M.A.,LPC
Phone: 210-719-0237