Provider Demographics
NPI:1295410611
Name:JOHNSON, BELEN EILEEN
Entity type:Individual
Prefix:
First Name:BELEN
Middle Name:EILEEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DYLAN
Other - Middle Name:EILEEN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:13705 NE 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-2952
Mailing Address - Country:US
Mailing Address - Phone:971-409-3989
Mailing Address - Fax:
Practice Address - Street 1:5500 NE 109TH CT STE A
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6104
Practice Address - Country:US
Practice Address - Phone:714-848-8319
Practice Address - Fax:714-596-6274
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician