Healthcare Provider Details

I. General information

NPI: 1033419734
Provider Name (Legal Business Name): CATHERINE ANN JOHNSTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE ANN LEAHY PLCSW

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W BROADWAY STE 3I
COLUMBIA MO
65203-3842
US

IV. Provider business mailing address

201 W BROADWAY STE 3I
COLUMBIA MO
65203-3842
US

V. Phone/Fax

Practice location:
  • Phone: 573-214-0436
  • Fax: 573-442-0606
Mailing address:
  • Phone: 573-214-0436
  • Fax: 573-442-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2011021063
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: