Provider Demographics
NPI:1245252626
Name:JOHNSON, MYRA LOUISE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MYRA
Middle Name:LOUISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 FENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-3606
Mailing Address - Country:US
Mailing Address - Phone:281-451-7444
Mailing Address - Fax:
Practice Address - Street 1:2206 FENWOOD DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-3606
Practice Address - Country:US
Practice Address - Phone:281-451-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037446402Medicaid
TX037446403Medicaid
TX037446403Medicaid
TX037446402Medicaid
TX8G0729Medicare ID - Type UnspecifiedTPI-GALVESTON COUNTY