Individual ProviderKhrystal JohnsonCounselorBehavioral Health & Social Service ProvidersPractice Address631 NE 102nd Ave, Portland, OR 97220-4004(971) 292-3874PECOS EnrollmentBased on the most recent information from CMS, provider Khrystal Johnson is legally eligible to order and refer claims for Part B and DME services only.Part BMedicare Part BEnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1720495534Provider TypeIndividualFull NameJohnson, KhrystalCredentialLPCGenderFemaleSole ProprietorYesEnumeration Date7/14/2014Last Updated5/15/2021Contact InformationPractice LocationPractice Address631 NE 102nd Ave, Portland, OR 97220-4004Phone(971) 292-3874Fax(971) 328-4735Mailing LocationMailing Address631 NE 102nd Ave, Portland, OR 97220-4004Phone(971) 292-3874Fax(971) 328-4735Provider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseC5540OregonCode101YA0400XDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode101YM0800XDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer