Provider Demographics
NPI:1366778151
Name:JOHNSON, LYNDA R (LPCS)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 SANTA FE TRL
Mailing Address - Street 2:STE 9
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-3063
Mailing Address - Country:US
Mailing Address - Phone:469-600-5056
Mailing Address - Fax:972-863-3263
Practice Address - Street 1:1106 SANTA FE TRL
Practice Address - Street 2:STE 9
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-3063
Practice Address - Country:US
Practice Address - Phone:469-600-5056
Practice Address - Fax:972-863-3263
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2014-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63935101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional