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General NPI Number Information
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NPI Number | 1508373796
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Entity Type | Organization
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Legal Business Name | L J PSYCHOLOGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 01/09/2018
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Last Update Date | 01/09/2018
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Provider Practice Location Address
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Address Line | 515 N CEDAR RIDGE DR STE 7E
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City | DUNCANVILLE
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State | TX
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Zip | 75116-3179
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Country | US
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Telephone | 469-600-5056
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Fax | 972-863-3382
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Provider Business Mailing Address
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Address Line | 1011 TRACY AVE
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City | DUNCANVILLE
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State | TX
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Zip | 75137-3550
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Country | US
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Telephone | 469-600-5056
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Fax | 972-863-3382
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR-S
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Name | MS. LYNDA JOHNSON
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Credential | LPC-S
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Telephone | 469-600-5056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 63935
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License Number State | TX
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