1457482077 NPI number — MR. RICHARD POWELL JOHNSON M.A.,CADCIII,NCGCII,

Table of content: MR. RICHARD POWELL JOHNSON M.A.,CADCIII,NCGCII, (NPI 1457482077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457482077 NPI number — MR. RICHARD POWELL JOHNSON M.A.,CADCIII,NCGCII,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
RICHARD
Provider Middle Name:
POWELL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.A.,CADCIII,NCGCII,
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457482077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
82 CERVANTES CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE OSWEGO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97035-1229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15630 SE 90TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLACKAMAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97015-9729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-235-2954
Provider Business Practice Location Address Fax Number:
503-675-9988
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 96-04-104 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 96-04-104 . This is a "ADDICTION COUNSELOR CERTIFICATION BOARD OF OREGON" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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