Provider Demographics
NPI:1679884340
Name:JOHNSTON, JAURES PRESCOTT JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAURES
Middle Name:PRESCOTT
Last Name:JOHNSTON
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 ASHURST RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-5626
Mailing Address - Country:US
Mailing Address - Phone:484-988-1625
Mailing Address - Fax:
Practice Address - Street 1:636 ASHURST RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-5626
Practice Address - Country:US
Practice Address - Phone:484-988-1625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004050L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist