Provider Demographics
NPI:1851411219
Name:JOHNSTON, MARY ANN (LPC, LMFT,LSOTP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LPC, LMFT,LSOTP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:QUIRK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1110 E BELGRAVIA DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-2228
Mailing Address - Country:US
Mailing Address - Phone:713-436-1441
Mailing Address - Fax:
Practice Address - Street 1:6300 WEST LOOP S
Practice Address - Street 2:SUITE 215
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2900
Practice Address - Country:US
Practice Address - Phone:713-667-5659
Practice Address - Fax:713-667-3198
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01230101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional