Provider Demographics
NPI:1689958142
Name:JOHNSTON, JAMIE SMITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:SMITH
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 BROOKS ST SE UNIT B602
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-3740
Mailing Address - Country:US
Mailing Address - Phone:850-362-8787
Mailing Address - Fax:
Practice Address - Street 1:1008 AIRPORT RD STE D
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2822
Practice Address - Country:US
Practice Address - Phone:850-362-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8403103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist