# ANJULI SHAH-JOHNSON

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043677198
- **Authorized official:** ANJULI SHAH-JOHNSON (OWNER/THERAPIST/BODYWORKER)
- **Authorized official phone:** (773) 991-0103

## Contact information

- **Practice address:** 1611 NE 16TH AVE, PORTLAND, OR 97232-1413
- **Practice address phone:** (773) 991-0103
- **Mailing address:** 1611 NE 16TH AVE, PORTLAND, OR 97232-1413

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | L5990 | OR | Yes |

## Other

- **Enumeration date:** 01/20/2016
- **Last updated:** 01/20/2016