Provider Demographics
NPI:1124220389
Name:JOHANSEN, KARA R (PSYD)
Entity type:Individual
Prefix:DR
First Name:KARA
Middle Name:R
Last Name:JOHANSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21810 WILLAMETTE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-3287
Mailing Address - Country:US
Mailing Address - Phone:503-994-4353
Mailing Address - Fax:
Practice Address - Street 1:21810 WILLAMETTE DR STE 200
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-3287
Practice Address - Country:US
Practice Address - Phone:503-994-4353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000002916103TC0700X
OR3190103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical