Provider Demographics
NPI:1578662334
Name:JOHNSTON, MONA S (PHD)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:S
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 FLAX ROAD
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-8962
Mailing Address - Country:US
Mailing Address - Phone:309-837-4294
Mailing Address - Fax:309-837-4294
Practice Address - Street 1:70 FLAX ROAD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-8962
Practice Address - Country:US
Practice Address - Phone:309-837-4294
Practice Address - Fax:309-837-4294
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL32038101Y00000X
IL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist