Individual
KYLIE R. JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRM
Contact information
Practice address
389 SW SCALEHOUSE CT STE 130, BEND, OR 97702-3241
(541) 306-4446
(541) 512-7090
Mailing address
389 SW SCALEHOUSE CT STE 130, BEND, OR 97702-3241
(541) 306-4446
(541) 512-7090
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
T221364
OR
101YM0800X
Mental Health Counselor
257467
OR
175T00000X
Peer Specialist
Primary
21-CRM-428
OR
Other
Enumeration date
03/31/2021
Last updated
11/10/2025
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