Provider Demographics
NPI:1780999847
Name:JOHNSTON, MICHAEL CLARENCE (MHS, LPC, CA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CLARENCE
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MHS, LPC, CA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1843 ROUTE 209
Mailing Address - Street 2:SOUTH SAFEWAY STORAGE SUITE 1
Mailing Address - City:SCIOTA
Mailing Address - State:PA
Mailing Address - Zip Code:18322
Mailing Address - Country:US
Mailing Address - Phone:570-426-0096
Mailing Address - Fax:
Practice Address - Street 1:1843 ROUTE 209
Practice Address - Street 2:SOUTH SAFEWAY STORAGE COMPLEX
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322
Practice Address - Country:US
Practice Address - Phone:570-426-0096
Practice Address - Fax:570-992-1723
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005541101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional