Provider Demographics
NPI:1346901881
Name:JOHNSTON, RUBY LEE (MC, LPC, SC, BHP)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:LEE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MC, LPC, SC, BHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20081 E ROSA RD
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-9799
Mailing Address - Country:US
Mailing Address - Phone:480-678-3677
Mailing Address - Fax:
Practice Address - Street 1:20081 E ROSA RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-9799
Practice Address - Country:US
Practice Address - Phone:480-678-3677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11863101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional