Provider Demographics
NPI:1437409414
Name:JOHNSON, MARLENA LAURA-JOANN (QMHP)
Entity Type:Individual
Prefix:MRS
First Name:MARLENA
Middle Name:LAURA-JOANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:MARLENA
Other - Middle Name:LAURA-JOANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:QMHP
Mailing Address - Street 1:901 BRUTSCHER ST STE D PMB 150
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-6096
Mailing Address - Country:US
Mailing Address - Phone:503-431-0063
Mailing Address - Fax:
Practice Address - Street 1:444 VILLA RD
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1856
Practice Address - Country:US
Practice Address - Phone:503-431-0063
Practice Address - Fax:503-554-1848
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0942651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical