Provider Demographics
NPI:1881378487
Name:JASON A JOHNSON PSYD LLC
Entity type:Organization
Organization Name:JASON A JOHNSON PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:503-853-4998
Mailing Address - Street 1:1020 SW TAYLOR ST STE 245
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2507
Mailing Address - Country:US
Mailing Address - Phone:503-853-4998
Mailing Address - Fax:
Practice Address - Street 1:1020 SW TAYLOR ST STE 245
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2507
Practice Address - Country:US
Practice Address - Phone:503-853-4998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)