Healthcare Provider Details

I. General information

NPI: 1467025536
Provider Name (Legal Business Name): JAROD JOHNSON LPC, LCDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 S 6TH ST
KLAMATH FALLS OR
97601-3372
US

IV. Provider business mailing address

2074 S 6TH ST
KLAMATH FALLS OR
97601-3372
US

V. Phone/Fax

Practice location:
  • Phone: 541-841-8110
  • Fax: 541-851-8114
Mailing address:
  • Phone: 541-841-8110
  • Fax: 541-851-8114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14751
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC8035
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number82350
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: