MEDICARE: MS. ANGELA FAYE JOHNSON 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	101YM0800X	Mental Health Counselor	66803	TX

General Provider Information

NPI Number	:	1639439771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA FAYE JOHNSON LPC

Provider Business Mailing Address
First Line	:	2450 LOUISIANA ST
Second Line	:	STE. 400 #122
City	:	HOUSTON
State	:	TX
Zip	:	77006-2380
Country	:	US
Telephone Number	:	713-446-9706
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 LOUISIANA ST
Second Line	:	STE. 400 #122
City	:	HOUSTON
State	:	TX
Zip	:	77006-2380
Country	:	US
Telephone Number	:	713-446-9706
Fax Number	:

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

Provider Enumeration Date	:	05/23/2012
Last Update Date	:	05/23/2012

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