Provider Demographics
NPI:1609474212
Name:JOHNSTON, JEFFREY ALAN
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15211-1329
Mailing Address - Country:US
Mailing Address - Phone:412-485-0310
Mailing Address - Fax:
Practice Address - Street 1:2400 ANSYS DR STE 102
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-0403
Practice Address - Country:US
Practice Address - Phone:412-737-0990
Practice Address - Fax:412-533-2696
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP2500X, 101Y00000X
PAPC012863101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor