Provider Demographics
NPI:1366740169
Name:JOHNSON, ANNA EILEEN (MA, LCDC, LPC INTERN)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:EILEEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LCDC, LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 QUAIL COVER CIR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5609
Mailing Address - Country:US
Mailing Address - Phone:512-567-8165
Mailing Address - Fax:
Practice Address - Street 1:12355 HYMEADOW DR.
Practice Address - Street 2:SUITE 450
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750
Practice Address - Country:US
Practice Address - Phone:512-567-8165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9556101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)