Provider Demographics
NPI:1699980672
Name:JOHNSON, LISA PAULINE (CMA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:PAULINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:PAULINE
Other - Last Name:MINOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:1907 J ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4285
Mailing Address - Country:US
Mailing Address - Phone:541-505-8166
Mailing Address - Fax:
Practice Address - Street 1:1790 W 11TH AVE
Practice Address - Street 2:SUITE 290
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3758
Practice Address - Country:US
Practice Address - Phone:541-686-1262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health