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General NPI Number Information
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NPI Number | 1508789595
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Entity Type | Individual
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Provider Name | RAYANN JOHANSON LPC-A, M.ED.
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Gender | Female
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Dates
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Enumeration Date | 08/04/2026
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Last Update Date | 08/04/2026
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Provider Practice Location Address
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Address Line | 777 MAIN ST STE 600
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City | FORT WORTH
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State | TX
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Zip | 76102-5368
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Country | US
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Telephone | 817-887-8157
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Fax |
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Provider Business Mailing Address
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Address Line | 200 W DAGGETT AVE APT 412
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City | FORT WORTH
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State | TX
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Zip | 76104-1295
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Country | US
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Telephone | 682-559-2506
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 102855
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License Number State | TX
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