Provider Demographics
NPI:1720110562
Name:JOHNSTON, JANET MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:MICHELLE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:MICHELLE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1111 S 119TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-1601
Mailing Address - Country:US
Mailing Address - Phone:402-871-1002
Mailing Address - Fax:402-991-7445
Practice Address - Street 1:1111 S 119TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-1601
Practice Address - Country:US
Practice Address - Phone:402-871-1002
Practice Address - Fax:402-991-7445
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE28461041C0700X
NE11461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE82003OtherBLUE CROSS BLUE SHIELD
NE100253396-00Medicaid
NE240598OtherMIDLANDS CHOICE