Healthcare Provider Details

I. General information

NPI: 1134049729
Provider Name (Legal Business Name): RYAN JOHNSTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 HIGHLAND AVE STE 308
NEEDHAM MA
02494-3034
US

IV. Provider business mailing address

175 HIGHLAND AVE STE 307
NEEDHAM MA
02494-3034
US

V. Phone/Fax

Practice location:
  • Phone: 781-474-5280
  • 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 StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: