Individual
MIKILAH TERAE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
831 NW COUNCIL DR STE 300, GRESHAM, OR 97030-3725
(503) 258-4600
Mailing address
11035 NE SANDY BLVD, PORTLAND, OR 97220-2553
(503) 258-4200
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
106H00000X
Marriage & Family Therapist
Primary
T1770
OR
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
08/21/2015
Last updated
10/06/2021
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