Provider Demographics
NPI:1114601648
Name:JOHNSTON, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 COUNTY ROAD 2660
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:MO
Mailing Address - Zip Code:65548-8146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6850 COUNTY ROAD 2660
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:MO
Practice Address - Zip Code:65548-8146
Practice Address - Country:US
Practice Address - Phone:417-934-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020011799101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health