Provider Demographics
NPI:1033181664
Name:JOHNSTON, JUDY (LPE)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 558
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-0558
Mailing Address - Country:US
Mailing Address - Phone:501-745-4584
Mailing Address - Fax:501-745-5921
Practice Address - Street 1:2526 HIGHWAY 65 S
Practice Address - Street 2:SUITE 202
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-6588
Practice Address - Country:US
Practice Address - Phone:501-745-4584
Practice Address - Fax:501-745-5921
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR77-11E101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health