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General NPI Number Information
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NPI Number | 1811026511
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Entity Type | Individual
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Provider Name | RAY THOMAS JOHNSTON L.C.S.W., S.A.P.
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Gender | Male
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 207A BLOUNT ST
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City | NACOGDOCHES
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State | TX
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Zip | 75965-3541
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Country | US
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Telephone | 936-569-8570
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Fax | 936-560-1144
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Provider Business Mailing Address
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Address Line | 207A BLOUNT ST
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City | NACOGDOCHES
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State | TX
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Zip | 75965-3541
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Country | US
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Telephone | 936-569-8570
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Fax | 936-560-1144
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 10482
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License Number State | TX
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