Stacy Kim Johnston Psychology, Inc.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

STACY KIM JOHNSTON PSYCHOLOGY, INC.

Practice address

501 W Broadway Ste 800
San Diego, CA 92101-3546

Phone

(619) 077-8072

NPI assigned

Sep 24, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stacy JohnstonNPI 1063569135

Title

Owner

Phone

(619) 077-8072

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stacy Kim Johnston, PHD

  • Clinical Psychologist
  • La Mesa, CA
  • NPI 1063569135
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600905600000",
    "number": "1316554322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 W BROADWAY STE 800",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921013546",
            "telephone_number": "619-077-8072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 W BROADWAY STE 800",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921013546",
            "telephone_number": "619-077-8072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STACY KIM JOHNSTON PSYCHOLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-24",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A",
        "authorized_official_last_name": "JOHNSTON",
        "authorized_official_first_name": "STACY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "619-077-8072"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna Kathleen Stachowicz, DNP, NP-C, CEN
• Shane Stachwick
• Corrie Elizabeth Stack
• Samantha Stack, PT, DPT
• Dawn Stackhouse Dickerson, M.ED, IBCLC, RLC, CD
• Mariah Stacy
• Denise Stading, N.P.
• Kaya R Stadler, M.S., BCBA
• Nima Stadler
• Nicole Ashley Stadnick, M.S.

• Clinical Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.