| NPI | 1770745457 |
|---|---|
| Professional Name | JACK EUGENE JOHNSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 00-11-45) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 21-QMHP-R-0965) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2023-09-28 |