Healthcare Provider Details

I. General information

NPI: 1316508831
Provider Name (Legal Business Name): JANAE JOHNSON QMHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8915 SW CENTER ST
TIGARD OR
97223-6307
US

IV. Provider business mailing address

8915 SW CENTER ST
TIGARD OR
97223-6307
US

V. Phone/Fax

Practice location:
  • Phone: 503-726-3690
  • Fax:
Mailing address:
  • Phone: 503-726-3690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberA14676
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: