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General NPI Number Information
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NPI Number | 1346453867
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Entity Type | Individual
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Provider Name | TESSA J JOHNSTON MA, LPCC
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Gender | Female
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 2929 COORS BLVD NW STE 203
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-1207
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Country | US
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Telephone | 505-977-1152
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Fax |
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Provider Business Mailing Address
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Address Line | 4802 SAN TIMOTEO AVE NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-3833
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Country | US
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Telephone | 505-977-1152
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CCMH0198971
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License Number State | NM
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