Provider Demographics
NPI:1114576600
Name:JOHNSTON, CASEY ANN VERLEE (TMFT)
Entity Type:Individual
Prefix:MRS
First Name:CASEY ANN
Middle Name:VERLEE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:TMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18219 150TH ST
Mailing Address - Street 2:
Mailing Address - City:DOUDS
Mailing Address - State:IA
Mailing Address - Zip Code:52551-8036
Mailing Address - Country:US
Mailing Address - Phone:641-919-3465
Mailing Address - Fax:
Practice Address - Street 1:103 E ADAMS AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-3461
Practice Address - Country:US
Practice Address - Phone:641-455-0636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist