Provider Demographics
NPI:1922810753
Name:JOHNSTON, NANCY (LPC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5652 HEARTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-4947
Mailing Address - Country:US
Mailing Address - Phone:815-351-6217
Mailing Address - Fax:
Practice Address - Street 1:1137 E 5000N RD
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-4229
Practice Address - Country:US
Practice Address - Phone:815-348-5375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178021191101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional