Provider Demographics
NPI:1407466287
Name:JOHNSTON, MESHALLE (LISW-S)
Entity Type:Individual
Prefix:
First Name:MESHALLE
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13006 MAPLEROW AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44105-6922
Mailing Address - Country:US
Mailing Address - Phone:216-401-0652
Mailing Address - Fax:
Practice Address - Street 1:13006 MAPLEROW AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44105-6922
Practice Address - Country:US
Practice Address - Phone:216-401-0652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21824458101YS0200X
OH3747P1801X, 374U00000X
OHI.0010097-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health Aide