Khrystal Johnson, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C5540 Issued in OR

Practice address

631 NE 102ND Ave
Portland, OR 97220-4004

Phone

(971) 292-3874

Fax

(971) 328-4735

NPI assigned

Jul 14, 2014

Last updated

May 15, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Cascadia Health

  dba Cascadia Behavioral Healthcare, Inc.

  • Primary Care Clinic/Center
  • Portland, OR
  • NPI 1144722935
  NPD (past)
• Cascadia Health

  dba Cascadia Behavioral Healthcare, Inc.

  • Multi-Specialty Clinic/Center
  • Portland, OR
  • NPI 1447337753
  NPD (past)

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

{
    "created_epoch": "1405296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621036800000",
    "number": "1720495534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 NE 102ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972204004",
            "telephone_number": "971-292-3874",
            "fax_number": "971-328-4735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 NE 102ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972204004",
            "telephone_number": "971-292-3874",
            "fax_number": "971-328-4735"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7525 SE Lake Rd",
            "address_purpose": "LOCATION",
            "city": "Milwaukie",
            "state": "OR",
            "postal_code": "972672115",
            "country_code": "US",
            "telephone_number": "503-303-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KHRYSTAL",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-14",
        "last_updated": "2021-05-15",
        "certification_date": "2021-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C5540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn M Johnson, RN, MS, CNS, CCRN
• Katie Johnson, LSWAIC
• Keith D Johnson, MAED
• Kelly Johnson
• Kendall M Johnson, L.C.S.W.
• Kimberly Ann Johnson, RDH
• Kyle Patrick Johnson, MD
• Latia Johnson
• Laurel Johnson, CSWA
• Laurel Leigh Johnson, DC, LAC, DIPL. OM

• Mental Health Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.