Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Stacy Kim Johnston, PHD

Individual provider Clinical Psychologist · NPI 1063569135

Dr. Stacy Kim Johnston, PHD is a Clinical Psychologist in LA Mesa, California. Qualified in 1998, 28 years ago. Practices as a sole proprietor, accepts Medicare assignment and offers telehealth. Licensed in California.

Years since qualifying
28
Licensed in
CA
In the registry since
2007
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

4730 Palm Ave 202
LA Mesa, CA 91941-5266
Phone: (619) 778-7215
Fax: (619) 328-9332
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence PSY17457 (CA)

Record details

NPI number1063569135
Entity typeIndividual (Type 1)
GenderFemale
Credentials PHD
Sole proprietorYes
NPI enumeratedJanuary 4, 2007
Last updated in NPPESAugust 19, 2013

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 1998 (28 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations4 on file with Medicare

Other providers in LA Mesa