Most Relevant Information
Provider Data
| NPI Number: | 1003411182 |
| Provider Name: | COLLEEN CASEY JOHNSON LCDC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | 14554 |
Most Important Dates
| Enumeration Date: | 12/04/2020 |
| Last Updated: | 12/04/2020 |
Provider Practice Location
3840 HULEN ST
FORT WORTH
TX
761077277
Practice Location Phone/Fax
| Phone: | 8173353022 |
| Fax: |
Provider Mailing Location
3840 HULEN ST
FORT WORTH
TX
761077277
Provider Mailing Phone/Fax
| Phone: | 8175694300 |
| Fax: |