MEDICARE: MRS. SHAHEEDRA AVEONNE JOHNSON M.S., LPC

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	101YP2500X	Professional Counselor	90422	TX

General Provider Information

NPI Number	:	1497599054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHAHEEDRA AVEONNE JOHNSON M.S., LPC

Provider Business Mailing Address
First Line	:	1925 JADE FOREST LN
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75181-4310
Country	:	US
Telephone Number	:	469-290-4285
Fax Number	:

Provider Business Practice Location Address
First Line	:	4040 N CENTRAL EXPY STE 670
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-3158
Country	:	US
Telephone Number	:	469-290-4285
Fax Number	:

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

Provider Enumeration Date	:	06/19/2024
Last Update Date	:	09/08/2025

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