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General NPI Number Information
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NPI Number | 1366050049
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Entity Type | Organization
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Legal Business Name | JOHNSON ABA, LLC
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Dates
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Enumeration Date | 07/17/2020
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Last Update Date | 07/17/2020
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Provider Practice Location Address
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Address Line | 17629 EL CAMINO REAL STE 104
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City | HOUSTON
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State | TX
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Zip | 77058-6005
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Country | US
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Telephone | 843-861-3477
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 58321
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City | WEBSTER
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State | TX
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Zip | 77598-8321
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESSICA LEIGH JOHNSON
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Credential |
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Telephone | 843-861-3477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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