Provider Demographics
NPI:1982323945
Name:JOHANNSON, JUSTIN JAMES (LPC)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:JAMES
Last Name:JOHANNSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2836 ZELKOVA CT NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-3361
Mailing Address - Country:US
Mailing Address - Phone:503-559-6008
Mailing Address - Fax:
Practice Address - Street 1:1698 LIBERTY ST SE # 170
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4348
Practice Address - Country:US
Practice Address - Phone:503-559-6008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC6838101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty