Provider Demographics
NPI:1346453867
Name:JOHNSTON, TESSA J (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:TESSA
Middle Name:J
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9180 COORS BLVD NW
Mailing Address - Street 2:APT 1704
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-3112
Mailing Address - Country:US
Mailing Address - Phone:505-977-1152
Mailing Address - Fax:505-890-0256
Practice Address - Street 1:9180 COORS BLVD NW
Practice Address - Street 2:APT 1704
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-3112
Practice Address - Country:US
Practice Address - Phone:505-977-1152
Practice Address - Fax:505-890-0256
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMLMHC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health