Individual
CONSTANCE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LPC-SUPERVISOR
Contact information
Practice address
601 PENDLETON ST, TEMPLE, TX 76504-2947
(254) 742-1524
(254) 742-0789
Mailing address
PO BOX 581, SALADO, TX 76571-0581
(254) 760-2960
(254) 947-5069
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
14874
TX
101YP2500X
Professional Counselor
Primary
14874
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
028373101
—
TX
01
—
26-0191219
PGBA / VALUE OPTIONS TRIC
TX
01
—
4067LC
BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/10/2006
Last updated
03/01/2012
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