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General NPI Number Information
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NPI Number | 1700031762
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Entity Type | Organization
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Legal Business Name | KEVIN J JOHNSON
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Dates
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Enumeration Date | 11/18/2008
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Last Update Date | 07/10/2009
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Provider Practice Location Address
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Address Line | 12805 CULLEN BLVD. D
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City | HOUSTON
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State | TX
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Zip | 77047
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Country | US
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Telephone | 713-738-6955
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Fax |
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Provider Business Mailing Address
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Address Line | 12805 CULLEN BLVD. D
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City | HOUSTON
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State | TX
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Zip | 77047
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Country | US
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Telephone | 713-738-6955
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. KEVIN JEROME JOHNSON
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Credential |
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Telephone | 713-738-6955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | H0554
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License Number State | TX
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