Provider Demographics
NPI:1003540311
Name:JOHNSTON, AMBER LEA (PLPC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LEA
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:LEA
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-3247
Mailing Address - Country:US
Mailing Address - Phone:573-433-4846
Mailing Address - Fax:
Practice Address - Street 1:103 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401
Practice Address - Country:US
Practice Address - Phone:573-433-4846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022020085101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional