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General NPI Number Information
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NPI Number | 1538552013
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Entity Type | Individual
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Provider Name | AMANDA JO JOHNSTON BS, LAC
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Gender | Female
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Dates
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Enumeration Date | 03/09/2015
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 316 2ND AVE W
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City | WILLISTON
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State | ND
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Zip | 58801-5218
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Country | US
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Telephone | 701-774-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 14TH ST W STE 290
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City | WILLISTON
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State | ND
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Zip | 58801-4078
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Country | US
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Telephone | 701-751-0299
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Fax | 701-713-3299
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 101YA0400X
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1980
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License Number State | ND
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