Provider Demographics
NPI:1871792192
Name:CONNIE JOHNSON, LPC, INC.
Entity type:Organization
Organization Name:CONNIE JOHNSON, LPC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:254-742-1524
Mailing Address - Street 1:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:SALADO
Mailing Address - State:TX
Mailing Address - Zip Code:76571-0581
Mailing Address - Country:US
Mailing Address - Phone:254-760-2960
Mailing Address - Fax:254-947-5069
Practice Address - Street 1:601 PENDLETON ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-2947
Practice Address - Country:US
Practice Address - Phone:254-742-1524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14874101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX028373101Medicaid
TX4067LCOtherBLUE CROSS BLUE SHIELD
TX4067LCOtherBLUE CROSS BLUE SHIELD