Provider Demographics
NPI:1275984452
Name:JOHNSTON, KEVIN
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 WEBSTER RD
Mailing Address - Street 2:#190
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-4276
Mailing Address - Country:US
Mailing Address - Phone:817-842-7801
Mailing Address - Fax:
Practice Address - Street 1:387 WEBSTER RD
Practice Address - Street 2:#190
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832-4276
Practice Address - Country:US
Practice Address - Phone:817-842-7801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health