Provider Demographics
NPI:1437761632
Name:JOHNSTON, DEVYN (TLLP)
Entity Type:Individual
Prefix:
First Name:DEVYN
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 WALTON BLVD
Mailing Address - Street 2:SUITE 445
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307
Mailing Address - Country:US
Mailing Address - Phone:248-413-5027
Mailing Address - Fax:
Practice Address - Street 1:1135 WALTON BLVD
Practice Address - Street 2:SUITE 445
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:248-413-5027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2023-03-13
Deactivation Date:2023-01-04
Deactivation Code:
Reactivation Date:2023-01-25
Provider Licenses
StateLicense IDTaxonomies
MI6362009598103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical