Healthcare Provider Details

I. General information

NPI: 1073263471
Provider Name (Legal Business Name): NATASHA GAYLE JOHNSTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATASHA VANDER WEIDE

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10024 OFFICE CENTER AVE STE 100
SAINT LOUIS MO
63128-1392
US

IV. Provider business mailing address

2885 W BATTLEFIELD ST
SPRINGFIELD MO
65807-3952
US

V. Phone/Fax

Practice location:
  • Phone: 314-729-7050
  • Fax: 314-729-0920
Mailing address:
  • Phone: 314-535-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2020011985
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: