Provider Demographics
NPI:1346453867
Name:JOHNSTON, TESSA J (MA, LPCC)
Entity type:Individual
Prefix:MS
First Name:TESSA
Middle Name:J
Last Name:JOHNSTON
Suffix:
Gender:
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4802 SAN TIMOTEO AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-3833
Mailing Address - Country:US
Mailing Address - Phone:505-977-1152
Mailing Address - Fax:
Practice Address - Street 1:2929 COORS BLVD NW STE 203
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1207
Practice Address - Country:US
Practice Address - Phone:505-977-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0198971101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional