Healthcare Provider Details

I. General information

NPI: 1689737629
Provider Name (Legal Business Name): JOSEPH L JOHNSTON II LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6051 FRANKFORT HWY SUITE 800
BENZONIA MI
49616-9558
US

IV. Provider business mailing address

8148 DEADSTREAM RD
HONOR MI
49640-9779
US

V. Phone/Fax

Practice location:
  • Phone: 231-882-2182
  • Fax:
Mailing address:
  • Phone: 231-325-3243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801079862
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: