Provider Demographics
NPI:1144249822
Name:JOHNSON, WANDA Y (LPC,LMFT, PHD)
Entity type:Individual
Prefix:DR
First Name:WANDA
Middle Name:Y
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC,LMFT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N WATSON RD
Mailing Address - Street 2:SUITE 144
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-6190
Mailing Address - Country:US
Mailing Address - Phone:817-633-2092
Mailing Address - Fax:817-633-2094
Practice Address - Street 1:1201 N WATSON RD
Practice Address - Street 2:SUITE 144
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-6190
Practice Address - Country:US
Practice Address - Phone:817-633-2092
Practice Address - Fax:817-633-2094
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1532106H00000X
TX08895101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752342350OtherTAX IDENTIFICATION NUMBER