Provider Demographics
NPI:1164944666
Name:JOHNSTONE, TEVA SHINAULT
Entity Type:Individual
Prefix:
First Name:TEVA
Middle Name:SHINAULT
Last Name:JOHNSTONE
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 1:9452 TELEPHONE RD # 306
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-2600
Mailing Address - Country:US
Mailing Address - Phone:805-443-1984
Mailing Address - Fax:
Practice Address - Street 1:260 MAPLE CT STE 125
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3519
Practice Address - Country:US
Practice Address - Phone:805-398-6017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1038261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical