Healthcare Provider Details

I. General information

NPI: 1881506384
Provider Name (Legal Business Name): BENJAMIN GEORGE JOHNSTUN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 S YELLOWSTONE HWY STE 111
IDAHO FALLS ID
83402-4342
US

IV. Provider business mailing address

1827 WHITNEY ST
IDAHO FALLS ID
83402-1701
US

V. Phone/Fax

Practice location:
  • Phone: 208-358-8313
  • Fax:
Mailing address:
  • Phone: 503-396-9993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6281537
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6281537
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6281537
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: