Individual
MR. MICHAEL D. JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
311 ALLUMBAUGH ST, BOISE, ID 83704-9208
(208) 375-6402
(208) 323-1850
Mailing address
311 ALLUMBAUGH ST, BOISE, ID 83704-9208
(208) 375-6402
(208) 323-1850
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY-359
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000100175
REGENCE BLUE SHIELD
ID
01
—
N9535
BLUE CROSS
ID
Enumeration date
01/22/2007
Last updated
11/14/2007
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