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General NPI Number Information
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NPI Number | 1871002121
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Entity Type | Organization
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Legal Business Name | HEATHER L JOHNSTON, LLC
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Dates
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Enumeration Date | 09/29/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2420 N COLISEUM BLVD STE 201
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City | FORT WAYNE
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State | IN
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Zip | 46805-3139
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Country | US
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Telephone | 260-498-8009
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Fax | 260-408-5309
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Provider Business Mailing Address
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Address Line | 2420 N COLISEUM BLVD STE 201
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City | FORT WAYNE
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State | IN
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Zip | 46805-3139
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Country | US
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Telephone | 260-498-8009
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Fax | 260-408-5309
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Authorized Official
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Title or Position | OWNER
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Name | HEATHER L JOHNSTON
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Credential | LCSW
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Telephone | 260-498-8009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 34004652A
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License Number State | IN
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