Provider Demographics
NPI:1073636320
Name:JOHNSTON, GEORGE D (PHD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:D
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-5955
Mailing Address - Country:US
Mailing Address - Phone:253-850-3866
Mailing Address - Fax:
Practice Address - Street 1:229 1ST AVE S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5955
Practice Address - Country:US
Practice Address - Phone:253-850-3866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY1566103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist