Provider Demographics
NPI:1255564803
Name:JOHNSTON, CHRYSTAL LYNNE (PHD)
Entity type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:LYNNE
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 1:710 S COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-9307
Mailing Address - Country:US
Mailing Address - Phone:501-499-8699
Mailing Address - Fax:
Practice Address - Street 1:710 S COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-9307
Practice Address - Country:US
Practice Address - Phone:501-499-8699
Practice Address - Fax:479-890-5364
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR10-22P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist