Provider Demographics
NPI:1639381544
Name:JOHNSTON, MAUREEN ROSE (MA, MFT)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ROSE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CALLE EL PADRE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032
Mailing Address - Country:US
Mailing Address - Phone:408-871-9180
Mailing Address - Fax:408-248-2271
Practice Address - Street 1:1101 S. WINCHESTER BLVD
Practice Address - Street 2:A-101
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:408-871-9180
Practice Address - Fax:408-248-2271
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 31776106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist