Individual provider Active NPI

Mallory Johnston, MHP

  • Mental Health Counselor
  • Mount Vernon, IL
National Provider Identifier
1972128544
Registry record updated Jun 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
4110 N Water Tower PL
Mount Vernon, IL 62864-6295
Phone
(618) 214-2760
NPI assigned
Jun 10, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

4110 N Water Tower PL
Mount Vernon, IL 62864-6295

Mailing address

2103 Forest Ave
Mount Vernon, IL 62864-4735
Phone (618) 214-2760

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
One Hope United PastSince Jun 14, 2020 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1591747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591747200000",
    "number": "1972128544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2103 FOREST AVE",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628644735",
            "telephone_number": "618-214-2760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 N WATER TOWER PL",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646295",
            "telephone_number": "618-214-2760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSTON",
        "first_name": "MALLORY",
        "credential": "MHP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-10",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.