Provider Demographics
NPI:1487090916
Name:JOHNSTON, HOLLY RAE (LMFT)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:RAE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40055 WALCOTT LN
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-7025
Mailing Address - Country:US
Mailing Address - Phone:951-764-1442
Mailing Address - Fax:
Practice Address - Street 1:41700 IVY ST
Practice Address - Street 2:SUITE B
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9438
Practice Address - Country:US
Practice Address - Phone:951-764-1442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53355106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist