Provider Demographics
NPI:1083152508
Name:JOHNS, JOSEPH (CADCI, CRM)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:JOHNS
Suffix:
Gender:M
Credentials:CADCI, CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10315 NE FREMONT ST APT 48
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3470
Mailing Address - Country:US
Mailing Address - Phone:503-560-0624
Mailing Address - Fax:503-723-6653
Practice Address - Street 1:704 MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1842
Practice Address - Country:US
Practice Address - Phone:503-560-0624
Practice Address - Fax:503-723-6653
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16-04-09101YA0400X
OR13-CRM-042175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist