Provider Demographics
NPI:1407076516
Name:JOHNSTON, JERI S (MFT, PSYD)
Entity Type:Individual
Prefix:DR
First Name:JERI
Middle Name:S
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MFT, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2239 TOWNSGATE RD STE 208
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2433
Mailing Address - Country:US
Mailing Address - Phone:805-497-3632
Mailing Address - Fax:805-497-6432
Practice Address - Street 1:2239 TOWNSGATE RD STE 208
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2433
Practice Address - Country:US
Practice Address - Phone:805-497-3632
Practice Address - Fax:805-497-6432
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34314106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist