=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588459184
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD TODD JOHNSTON JR. LPC-MHSP, LMHC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2025
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4393 US HIGHWAY 27
-----------------------------------------------------
City | BRANFORD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32008-2461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-879-0428
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 895 SW BROOKDALE DR
-----------------------------------------------------
City | LAKE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32025-6514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-879-0428
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6888
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH26899
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------