Individual
MR. KEITH D JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MAED
Contact information
Practice address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(503) 445-0436
Mailing address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
Primary
—
—
Other
Enumeration date
06/21/2012
Last updated
06/21/2012
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