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General NPI Number Information
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NPI Number | 1679052120
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Entity Type | Individual
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Provider Name | BRENDA JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 1423 H G MOSLEY PKWY UNIT 101
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City | LONGVIEW
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State | TX
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Zip | 75604-4475
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Country | US
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Telephone | 469-753-9990
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Fax | 469-533-8872
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Provider Business Mailing Address
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Address Line | 1423 H G MOSLEY PKWY UNIT 101
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City | LONGVIEW
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State | TX
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Zip | 75604-4475
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Country | US
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Telephone | 469-753-9990
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Fax | 469-533-8872
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 4277
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 79344
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License Number State | TX
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