Individual
MR. MARK IVAN JOHNSTUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1181 SW RAMSEY AVE, GRANTS PASS, OR 97527-5835
(541) 476-2373
(541) 476-1526
Mailing address
1215 SW G ST, GRANTS PASS, OR 97526-2544
(541) 476-2373
(541) 476-1526
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C2179
OR
Other
Enumeration date
07/01/2011
Last updated
02/07/2024
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