MEDICARE: CHRISTOPHER L. JOHNSTON,PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180004094	IL

General Provider Information

NPI Number	:	1457627598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTOPHER L. JOHNSTON,PH.D.

Provider Business Mailing Address
First Line	:	706 GREEN BAY RD
Second Line	:	SUITE3
City	:	GLENCOE
State	:	IL
Zip	:	60022-1590
Country	:	US
Telephone Number	:	847-835-7242
Fax Number	:

Provider Business Practice Location Address
First Line	:	706 GREEN BAY RD
Second Line	:	SUITE3
City	:	GLENCOE
State	:	IL
Zip	:	60022-1590
Country	:	US
Telephone Number	:	847-835-7242
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR/PSYCHOLOGICAL CONSULTANT
Name	:	DR. CHRISTOPHER LEE JOHNSTON
Credential	:	LCPC
Telephone Number	:	847-835-7242

Provider Enumeration Date	:	03/22/2012
Last Update Date	:	03/22/2012

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