Basic Information
| Provider Information | |||||||||
| NPI: | 1205335387 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSTON | ||||||||
| FirstName: | KRISTINA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | CDP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4672 | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992200672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094565465 | ||||||||
| FaxNumber: | 5094565710 | ||||||||
| Practice Location | |||||||||
| Address1: | 1321 N ASH ST | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992012803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093273120 | ||||||||
| FaxNumber: | 5093273228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2018 | ||||||||
| LastUpdateDate: | 09/26/2018 | ||||||||
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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 | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 60344329 | 05 | WA | MEDICAID |