Provider Demographics
NPI:1497952857
Name:JOHNSON, ALLAN MICHAEL (PHD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:MICHAEL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:A.
Other - Middle Name:MICHAEL
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:101 W 6TH ST
Mailing Address - Street 2:SUITE 604
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2942
Mailing Address - Country:US
Mailing Address - Phone:512-928-4357
Mailing Address - Fax:
Practice Address - Street 1:101 W 6TH ST
Practice Address - Street 2:SUITE 604
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2942
Practice Address - Country:US
Practice Address - Phone:512-928-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25085103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling