Provider Demographics
NPI:1932665981
Name:JOHNSON, EMILY COLLEN
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:COLLEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E 19TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-9126
Mailing Address - Country:US
Mailing Address - Phone:503-724-9117
Mailing Address - Fax:
Practice Address - Street 1:850 S 42ND ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-6670
Practice Address - Country:US
Practice Address - Phone:541-485-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health