Basic Information
| Provider Information | |||||||||
| NPI: | 1033181664 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSTON | ||||||||
| FirstName: | JUDY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.P.E. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 558 | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720310558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017454584 | ||||||||
| FaxNumber: | 5017455921 | ||||||||
| Practice Location | |||||||||
| Address1: | 2526 HIGHWAY 65 S | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | CLINTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720316588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017454584 | ||||||||
| FaxNumber: | 5017455921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 08/01/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 77-11E | AR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.