Healthcare Provider Details

I. General information

NPI: 1508777160
Provider Name (Legal Business Name): BRENNAN JOHNSTON PSYCHOTHERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 55TH ST STE 108
CLARENDON HILLS IL
60514-1597
US

IV. Provider business mailing address

276 E DEERPATH STE 428
LAKE FOREST IL
60045-1940
US

V. Phone/Fax

Practice location:
  • Phone: 847-204-2037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRENNAN JOHNSTON
Title or Position: MANAGER
Credential: LCPC
Phone: 847-204-2037