Provider Demographics
NPI:1679911218
Name:JOHNSON, JANEE (MS CAP)
Entity Type:Individual
Prefix:
First Name:JANEE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5227 SE MALDEN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-9058
Mailing Address - Country:US
Mailing Address - Phone:772-528-7549
Mailing Address - Fax:
Practice Address - Street 1:5227 SE MALDEN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-9058
Practice Address - Country:US
Practice Address - Phone:772-528-7549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5744101YA0400X
FLIMH9154101YM0800X
ORC4492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)