Provider Demographics
NPI:1093482424
Name:JOHNSTON, TAYLOR CHRISTINE (QMHA, CADC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:CHRISTINE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:QMHA, CADC
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:CHRISTINE
Other - Last Name:BURGESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 S. J. ST.
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97630
Mailing Address - Country:US
Mailing Address - Phone:541-947-2114
Mailing Address - Fax:541-947-4404
Practice Address - Street 1:35 S. G. ST.
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:OR
Practice Address - Zip Code:97630
Practice Address - Country:US
Practice Address - Phone:541-947-6021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator