Provider Demographics
NPI:1689866428
Name:JOHNSTON, DIANE (MFT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:BARBARA SINATRA CHILDREN'S CENTER
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-340-2336
Mailing Address - Fax:760-340-1851
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:BARBARA SINATRA CHILDREN'S CENTER
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-340-2336
Practice Address - Fax:760-340-1851
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT23985106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist