Provider Demographics
NPI:1861966087
Name:JOHNSTON, KIMSON F (MA, LMFT)
Entity type:Individual
Prefix:
First Name:KIMSON
Middle Name:F
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92871
Mailing Address - Country:US
Mailing Address - Phone:714-253-7675
Mailing Address - Fax:657-286-5272
Practice Address - Street 1:1370 BREA BLVD SUITE 210
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835
Practice Address - Country:US
Practice Address - Phone:714-253-7675
Practice Address - Fax:657-286-5272
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45925106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist