Healthcare Provider Details

I. General information

NPI: 1588459184
Provider Name (Legal Business Name): RICHARD TODD JOHNSTON JR. LPC-MHSP, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4393 US HIGHWAY 27
BRANFORD FL
32008-2461
US

IV. Provider business mailing address

895 SW BROOKDALE DR
LAKE CITY FL
32025-6514
US

V. Phone/Fax

Practice location:
  • Phone: 731-879-0428
  • Fax:
Mailing address:
  • Phone: 731-879-0428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6888
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH26899
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: