Individual provider Active NPI

Lindley Robert Johnson, LPC, MAC

  • Counselor
  • Portland, OR
National Provider Identifier
1124177050
Registry record updated Sep 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Practice address
621 SW Alder St
Suite 520
Portland, OR 97205-3626
Phone
(503) 494-4745
Fax
(205) 494-4747
NPI assigned
Jan 9, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X Primary

Addresses

Primary practice location

621 SW Alder St
Suite 520
Portland, OR 97205-3626

Mailing address

621 SW Alder St Ste 520
Portland, OR 97205-3620
Phone (503) 418-0885

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240103000950 OR Practitioner - Mental Health Counselor 5597115527 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Professional ServicesGroup PAC ID 4880760107, 1,683 clinicians

Practice addresses (Care Compare)

15700 SW Greystone CT
Beaverton, OR 97006-6011
Phone (503) 494-3442

2525 SW 1St Ave
Portland, OR 97201-4753

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
University Professional Services Current Accepting new patients
University Professional Services CurrentSince Jan 1, 2024 Accepting new patients
University Professional Services CurrentSince Jan 1, 2024 Accepting new patients

Locations

15700 SW Greystone Ct
Beaverton, OR 97006
Phone (503) 203-1000

621 SW Alder St
Ste 520
Portland, OR 97205
Phone (503) 418-5311

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378857600000",
    "number": "1124177050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 SW ALDER ST STE 520",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972053620",
            "telephone_number": "503-418-0885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 SW ALDER ST",
            "address_2": "SUITE 520",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972053626",
            "telephone_number": "503-494-4745",
            "fax_number": "205-494-4747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "LINDLEY",
        "middle_name": "ROBERT",
        "credential": "LPC, MAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2013-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.