Provider Demographics
NPI:1669284048
Name:JOHNSTUN, ERIC BLAKE (LPC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:BLAKE
Last Name:JOHNSTUN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 W BALSAM DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-3960
Mailing Address - Country:US
Mailing Address - Phone:480-353-8140
Mailing Address - Fax:
Practice Address - Street 1:4864 E BASELINE RD STE 106
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4629
Practice Address - Country:US
Practice Address - Phone:480-877-1486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-23630101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health