Provider Demographics
NPI:1356689897
Name:JOHNSTON, CHRISTOPHER L (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:L
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 GREEN BAY ROAD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022
Mailing Address - Country:US
Mailing Address - Phone:847-835-7242
Mailing Address - Fax:
Practice Address - Street 1:706 GREEN BAY ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022
Practice Address - Country:US
Practice Address - Phone:847-835-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004094101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor