Provider Demographics
NPI:1568739746
Name:JOHNSTON, MATT ALLEN (LPC, CADC II)
Entity Type:Individual
Prefix:MR
First Name:MATT
Middle Name:ALLEN
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:LPC, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8004 N INTERSTATE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-6631
Mailing Address - Country:US
Mailing Address - Phone:971-319-3649
Mailing Address - Fax:
Practice Address - Street 1:722 N SUMNER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-2641
Practice Address - Country:US
Practice Address - Phone:719-319-3649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10-03-45U101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)