Basic Information
Provider Information | |||||||||
NPI: | 1457715971 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | JOHNSTON | ||||||||
FirstName: | AMANDA | ||||||||
MiddleName: | C. M. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PLPC, PLMFT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 115 KEATING DR | ||||||||
Address2: |   | ||||||||
City: | BELLE CHASSE | ||||||||
State: | LA | ||||||||
PostalCode: | 700371629 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5043935750 | ||||||||
FaxNumber: | 5043935760 | ||||||||
Practice Location | |||||||||
Address1: | 115 KEATING DR | ||||||||
Address2: |   | ||||||||
City: | BELLE CHASSE | ||||||||
State: | LA | ||||||||
PostalCode: | 700371629 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5043935750 | ||||||||
FaxNumber: | 5043935760 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/11/2016 | ||||||||
LastUpdateDate: | 07/19/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/19/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 4703 | CA | N |   | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | 103148 | CA | N |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   | 106H00000X | PLM1394 | LA | N |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   | 101YP2500X | PLC8092 | LA | Y |   | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.