Provider Demographics
NPI:1356668933
Name:JOHNSTON, TIMOTHY DAVID (LMFT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DAVID
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 DOUGLAS BLVD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3844
Mailing Address - Country:US
Mailing Address - Phone:916-764-2325
Mailing Address - Fax:916-787-6222
Practice Address - Street 1:3300 DOUGLAS BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3844
Practice Address - Country:US
Practice Address - Phone:916-764-2325
Practice Address - Fax:916-787-6222
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45370106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist