MEDICARE: LUCINDA JOHNSTONE LPC, LCDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	11257	TX
2	101YP2500X	Professional Counselor	61567	TX

General Provider Information

NPI Number	:	1659670263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCINDA JOHNSTONE LPC, LCDC

Provider Business Mailing Address
First Line	:	56 FLAG LAKE PLZ
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-6263
Country	:	US
Telephone Number	:	979-297-4335
Fax Number	:	979-297-4315

Provider Business Practice Location Address
First Line	:	56 FLAG LAKE PLZ
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-6263
Country	:	US
Telephone Number	:	979-297-4335
Fax Number	:	979-297-4315

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2011
Last Update Date	:	03/22/2011

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