| Doctor Name: | MARY A. JOHNSON |
| NPI Number: | 1154681963 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D., LPC |
| License Number: | 92271 |
| Business Practice Address: | 202 Se Dorion Ave Suite 103 Pendleton, OR - 978012576 |
| Business Phone Number: | 5412762471 |
| Business Fax Number: | |
| Mailing Address: | 202 Se Dorion Ave, Suite 103 PENDLETON |
| State: | OR |
| Postal Code: | 978012576 |
| Phone Number: | 5412762471 |
| Fax Number: | |
| NPI Enumeration Date: | 05/25/2012 |
| NPI Last Update Date: | 05/25/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 92271 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |