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General NPI Number Information
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NPI Number | 1790579738
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Entity Type | Individual
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Provider Name | JANESSA JOHNSON LPC-A
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Gender | Female
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 983 BEACHSIDE DR
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City | CHANDLER
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State | TX
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Zip | 75758-5143
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Country | US
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Telephone | 716-560-2371
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Fax |
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Provider Business Mailing Address
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Address Line | 6811 S LAKEWOODS DR
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City | GEORGETOWN
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State | TX
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Zip | 78633-9554
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Country | US
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Telephone | 716-560-2371
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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 | 97510
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License Number State | TX
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