Provider Demographics
NPI:1124177050
Name:JOHNSON, LINDLEY ROBERT (LPC, MAC)
Entity type:Individual
Prefix:
First Name:LINDLEY
Middle Name:ROBERT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LPC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 SW ALDER ST STE 520
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-3620
Mailing Address - Country:US
Mailing Address - Phone:503-418-0885
Mailing Address - Fax:
Practice Address - Street 1:621 SW ALDER ST
Practice Address - Street 2:SUITE 520
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3626
Practice Address - Country:US
Practice Address - Phone:503-494-4745
Practice Address - Fax:205-494-4747
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor