Healthcare Provider Details

I. General information

NPI: 1598647208
Provider Name (Legal Business Name): MCKENZIE JOHNSTON PCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1584 NE 8TH ST STE 200
GRESHAM OR
97030-5746
US

IV. Provider business mailing address

10805 SE LONG ST
PORTLAND OR
97266-3446
US

V. Phone/Fax

Practice location:
  • Phone: 971-421-8696
  • Fax:
Mailing address:
  • Phone: 541-913-1940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: