Healthcare Provider Details

I. General information

NPI: 1497591754
Provider Name (Legal Business Name): JENNIFER JOHNSTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2024
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1846 E INNOVATION PARK DR STE 100
ORO VALLEY AZ
85755-1963
US

IV. Provider business mailing address

1846 E INNOVATION PARK DR STE 100
ORO VALLEY AZ
85755-1963
US

V. Phone/Fax

Practice location:
  • Phone: 520-510-5499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLPC-24850
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: