Provider Demographics
NPI:1275734733
Name:JOHNSTON, HOLLY KATHLEEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:KATHLEEN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 JOHNNYS WAY
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-5667
Mailing Address - Country:US
Mailing Address - Phone:512-947-8655
Mailing Address - Fax:512-268-4152
Practice Address - Street 1:601 W 18TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1111
Practice Address - Country:US
Practice Address - Phone:512-947-8655
Practice Address - Fax:512-268-4152
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX364471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical