Provider Demographics
NPI:1649462615
Name:JOHNSTON, THOMAS JOHN (MED, LMP, LMHC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JOHN
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MED, LMP, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12623 NE 110TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-4709
Mailing Address - Country:US
Mailing Address - Phone:425-827-1144
Mailing Address - Fax:425-827-1144
Practice Address - Street 1:12623 NE 110TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-4709
Practice Address - Country:US
Practice Address - Phone:425-827-1144
Practice Address - Fax:425-827-1144
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00000303225700000X
WA60034547101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist