Provider Demographics
NPI:1114050507
Name:JOHNSTONE, STACY HALL (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:HALL
Last Name:JOHNSTONE
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:340 ROSEWOOD AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-5927
Mailing Address - Country:US
Mailing Address - Phone:805-482-5221
Mailing Address - Fax:805-987-7994
Practice Address - Street 1:340 ROSEWOOD AVE
Practice Address - Street 2:SUITE G
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5927
Practice Address - Country:US
Practice Address - Phone:805-482-5221
Practice Address - Fax:805-987-7994
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY20946103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical