Provider Demographics
NPI:1003356585
Name:JOHNSTON, BILLY
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 W 60TH PL
Mailing Address - Street 2:APT 102
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5972
Mailing Address - Country:US
Mailing Address - Phone:786-838-1709
Mailing Address - Fax:
Practice Address - Street 1:2745 W 60TH PL
Practice Address - Street 2:APT 102
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5972
Practice Address - Country:US
Practice Address - Phone:786-838-1709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician