MEDICARE: LISA JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	39004170A	IN
2	101YP2500X	Professional Counselor	92921	TX
3	101YM0800X	Mental Health Counselor	TPMC6184	FL

General Provider Information

NPI Number	:	1295273035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA JOHNSON

Provider Business Mailing Address
First Line	:	13922 BONNERCREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-6175
Country	:	US
Telephone Number	:	219-805-4933
Fax Number	:

Provider Business Practice Location Address
First Line	:	13922 BONNERCREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-6175
Country	:	US
Telephone Number	:	219-805-4933
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2017
Last Update Date	:	06/03/2026

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