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General NPI Number Information
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NPI Number | 1710998133
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Entity Type | Individual
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Provider Name | KATIE JEAN JOHNSON M.ED.
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Gender | Female
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 1666 N HAMPTON RD SUITE 112
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City | DESOTO
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State | TX
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Zip | 75115-2390
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Country | US
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Telephone | 469-235-3477
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Fax | 469-519-3918
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Provider Business Mailing Address
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Address Line | 1918 RANGER DR
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City | GLENN HEIGHTS
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State | TX
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Zip | 75154-8816
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Country | US
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Telephone | 469-235-3477
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Fax | 469-519-3918
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 19793
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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 | 2561
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License Number State | AZ
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