Healthcare Provider Details

I. General information

NPI: 1780506550
Provider Name (Legal Business Name): MRS. ALYSSA JOHNSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 E BEVERLY AVE STE B
KINGMAN AZ
86409-3564
US

IV. Provider business mailing address

3451 CHARLESTON ST
KINGMAN AZ
86401-2303
US

V. Phone/Fax

Practice location:
  • Phone: 928-753-9383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: