Healthcare Provider Details

I. General information

NPI: 1609450196
Provider Name (Legal Business Name): JOHNNY YORGA LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
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

5010 SE FOSTER RD UNIT 86540
PORTLAND OR
97286-0840
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC10952
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: