Dr Clifford Alan Johannsen, PHD is a medicare enrolled "Marriage & Family Therapist" provider in Salem, Oregon. His current practice location is
635 Church St Ne, Salem, Oregon. You can reach out to his office (for appointments etc.) via phone at
(503) 399-9691.
Dr Clifford Alan Johannsen is licensed to practice in Oregon (license number 0935) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1962627901.
Healthcare Provider's Profile
| Full Name | Dr Clifford Alan Johannsen |
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| Gender | Male |
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| Speciality | Marriage & Family Therapist |
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| Location | 635 Church St Ne, Salem, Oregon |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1962627901
- Provider Enumeration Date: 04/16/2007
- Last Update Date: 07/08/2007
Medicare PECOS Information:
- PECOS PAC ID: 4082778519
- Enrollment ID: I20090129000006
Medical Identifiers
Medical identifiers for Dr Clifford Alan Johannsen such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1962627901 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 103T00000X | Psychologist | 0935 (Oregon) | Primary |
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | 0935 (Oregon) | Primary |
| 103TB0200X | Psychologist - Cognitive & Behavioral | 0935 (Oregon) | Primary |
| 103TC0700X | Psychologist - Clinical | 0935 (Oregon) | Primary |
| 103TC2200X | Psychologist - Clinical Child & Adolescent | 0935 (Oregon) | Primary |
| 103TF0200X | Psychologist - Forensic | 0935 (Oregon) | Primary |
| 103TP2701X | Psychologist - Group Psychotherapy | 0935 (Oregon) | Primary |
| 106H00000X | Marriage & Family Therapist | 0935 (Oregon) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Clifford Alan Johannsen is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Clifford Alan Johannsen, PHD
Po Box 2004,
Lake Oswego, OR 97035-0626
Ph: (503) 246-5986 | Dr Clifford Alan Johannsen, PHD
635 Church St Ne,
Salem, OR 97301-2402
Ph: (503) 399-9691 |
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