Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Jack Eugene Johnson Sr., CADCII/QMHP-C, CSWA

Individual provider Addiction (Substance Use Disorder) Counselor · NPI 1770745457

Mr. Jack Eugene Johnson Sr., CADCII/QMHP-C, CSWA is an Addiction (Substance Use Disorder) Counselor in Gresham, Oregon. Licensed in Oregon. Registered with an NPI since 2008.

Licensed in
OR
In the registry since
2008
Specialties on file
3
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Practice location Address checks out

355 NW Division St
Gresham, OR 97030-5523
Phone: (503) 231-2641
Fax: (503) 231-1654
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Addiction (Substance Use Disorder) Counselor (primary) Taxonomy 101YA0400X · Licence 00-11-45 (OR)
Clinical Social Worker Taxonomy 1041C0700X · Licence A11750 (OR)
Mental Health Counselor Taxonomy 101YM0800X · Licence 24-QMHPC-001514 (OR)

Record details

NPI number1770745457
Entity typeIndividual (Type 1)
GenderMale
Credentials CADCII/QMHP-C , CSWA
Sole proprietorNo
NPI enumeratedJune 25, 2008
Last updated in NPPESAugust 3, 2026
Certification dateAugust 3, 2026

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