Provider Demographics
NPI:1295984813
Name:JOHNSTON, ANGELA MAY (MS)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MAY
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18829 65TH PL W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4170
Mailing Address - Country:US
Mailing Address - Phone:206-512-4459
Mailing Address - Fax:
Practice Address - Street 1:1900 N 175TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-5104
Practice Address - Country:US
Practice Address - Phone:206-533-9984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60747375106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALF60747375OtherMARRIAGE AND FAMILY THERAPIST LICENSE NUMBER