Provider Demographics
NPI:1598998114
Name:JOHNSTONE, TAMARA LEE (LMFT)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LEE
Last Name:JOHNSTONE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6691 BERYL ST
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-4605
Mailing Address - Country:US
Mailing Address - Phone:909-996-4845
Mailing Address - Fax:
Practice Address - Street 1:6691 BERYL ST
Practice Address - Street 2:
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91701-4605
Practice Address - Country:US
Practice Address - Phone:909-996-4845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-30
Last Update Date:2009-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46267106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist