Provider Demographics
NPI:1396317160
Name:JOHNSTON, MEGAN (LCSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22909 EAGLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-9525
Mailing Address - Country:US
Mailing Address - Phone:907-223-7155
Mailing Address - Fax:
Practice Address - Street 1:701 W 41ST AVE STE 104
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6604
Practice Address - Country:US
Practice Address - Phone:907-782-4553
Practice Address - Fax:907-563-0131
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-08-20
Deactivation Date:2021-08-12
Deactivation Code:
Reactivation Date:2021-08-20
Provider Licenses
StateLicense IDTaxonomies
AKCSWS8081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK2135655Medicaid