Provider Demographics
NPI:1861487019
Name:JOHNSTON, IRMA B (PSYD)
Entity Type:Individual
Prefix:DR
First Name:IRMA
Middle Name:B
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 FAR HILLS AVE
Mailing Address - Street 2:STE 304
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1687
Mailing Address - Country:US
Mailing Address - Phone:937-299-0636
Mailing Address - Fax:937-294-4669
Practice Address - Street 1:2600 FAR HILLS AVE
Practice Address - Street 2:STE 304
Practice Address - City:OAKWOOD
Practice Address - State:OH
Practice Address - Zip Code:45419-1687
Practice Address - Country:US
Practice Address - Phone:937-299-0636
Practice Address - Fax:937-294-4669
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3652103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical