Provider Demographics
NPI:1861079881
Name:JOHNSON, KEONTA FRAZIER (LPC)
Entity type:Individual
Prefix:MRS
First Name:KEONTA
Middle Name:FRAZIER
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 S SHERWOOD FOREST BLVD STE 104-418
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6400
Mailing Address - Country:US
Mailing Address - Phone:985-517-5272
Mailing Address - Fax:
Practice Address - Street 1:4520 S SHERWOOD FOREST BLVD STE 104-418
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-6400
Practice Address - Country:US
Practice Address - Phone:985-517-5272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6211101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty