| Beth Johnston, Lcsw, Pllc | |
|
5758 Elaine Dr Ste 110 Rockford IL 61108-3102 | |
| (815) 289-8619 | |
| Not Available |
| Full Name | Beth Johnston, Lcsw, Pllc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 5758 Elaine Dr Ste 110, Rockford, Illinois |
| Authorized Official Name and Position | Elizabeth Johnston (OWNER) |
| Authorized Official Contact | 8152898619 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Beth Johnston, Lcsw, Pllc 5758 Elaine Dr Ste 110 Rockford IL 61108-3102 Ph: () - | Beth Johnston, Lcsw, Pllc 5758 Elaine Dr Ste 110 Rockford IL 61108-3102 Ph: (815) 289-8619 |
| NPI Number | 1659023885 |
|---|---|
| Provider Enumeration Date | 01/19/2022 |
| Last Update Date | 01/19/2022 |
| Certification Date | 01/19/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659023885 | NPI | - | NPPES |
| 1891343877 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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