Jackie Eugene Johnson in Portland - Mental Health
Jackie Eugene Johnson - NPI 1770745457
Jackie Eugene Johnson is a Mental Health in Portland, Oregon. Jackie Eugene Johnson practices all healthcare services and medical treatments related to Mental Health. The NPI Number for Jackie Eugene Johnson is 1770745457. The last update date is 2023-09-28.
Jackie Eugene Johnson's current location address is 1631 Sw Coumbia St, Portland, Oregon. You can contact this provider via phone number 5032312641 and fax number 5032311654. The mailing address for Jackie Eugene Johnson is 1631 Sw Coumbia St, Portland, Oregon. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Jackie Eugene Johnson |
|---|---|
| Address | 1631 Sw Coumbia St, Portland, Oregon |
| Phone Number | 5032312641 |
| Fax Number | 5032311654 |
| Sole Proprietor | N |
| Credentials | CADC II/QM |
NPI Number Detail
| NPI Number | 1770745457 |
|---|---|
| Provider Enumeration Date | 2008-06-25 |
| Last Updated Date | 2023-09-28 |
Provider Mailing Address Detail
| Address | 1631 Sw Coumbia St |
|---|---|
| City | Portland |
| State | Oregon (OR) |
| Post Code | 97201 |
| Phone Number | 5032312641 |
| Fax Number | 5032311654 |
Provider's Primary Taxonomy Detail
| Speciality | Mental Health |
|---|---|
| Taxonomy | 101Ym0800X |
| Licence No | 21-QMHP-R-09 |
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Definition: A counselor who helps people manage conditions like depression, anxiety, grief, relationship issues, and more. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 500800849 | OR | -- | |
| 500801135 | OR | -- |
Post Comment/ Review Below
What is the unique 10-digit identifier code assigned to Jackie Eugene Johnson by the Centers for Medicare & Medicaid Services?
The Jackie Eugene Johnson has been issued the NPI (National Provider Identifier) 1770745457 by the CMS (Centers for Medicare & Medicaid Services), which serves as a unique identification number for healthcare providers.
Could you please share the complete physical location address where Jackie Eugene Johnson's facilities are situated?
The facilities of Jackie Eugene Johnson are physically located at the following address: 1631 Sw Coumbia St, Portland, OR, 97201.
What is the Jackie Eugene Johnson's area of specialization and corresponding taxonomy classification?
The Jackie Eugene Johnson's specialty field is Mental Health, and it falls under the taxonomy code 101Ym0800X, which categorizes healthcare providers based on their specialties.
On what date did the Jackie Eugene Johnson receive the assignment of its 1770745457 from the Centers for Medicare & Medicaid Services?
The Jackie Eugene Johnson was issued its 1770745457 by the Centers for Medicare & Medicaid Services on 2008-06-25.
As of what date was the information pertaining to Jackie Eugene Johnson, such as address, specialty, and other details, last reviewed and confirmed to be accurate?
The information related to Jackie Eugene Johnson, including its address, specialty, and other relevant details, was last reviewed and confirmed to be accurate on 2023-09-28.