Provider Demographics
NPI:1760772347
Name:JOHNSTON, PAULA M (PLPC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:M
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 DOCTORS PARK
Mailing Address - Street 2:SUITE C
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4927
Mailing Address - Country:US
Mailing Address - Phone:573-332-1900
Mailing Address - Fax:573-332-0444
Practice Address - Street 1:69 DOCTORS PARK
Practice Address - Street 2:SUITE C
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4927
Practice Address - Country:US
Practice Address - Phone:573-332-1900
Practice Address - Fax:573-332-0444
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011009616101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health