Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1770745457 Individual Practitioner Male Practitioner

Jack Eugene Johnson , CADC II, QMHP-C, CSWA

Counselor - Addiction (Substance Use Disorder) • Gresham, OR

Professional Overview & Biography Verified Profile Summary

Jack Johnson, CADC II, QMHP-C, CSWA is a registered healthcare professional specializing in Counselor - Addiction (Substance Use Disorder) in Gresham, OR. Practice services are available at 355 NW DIVISION ST under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

355 Nw Division St

Gresham, OR 970305523

Telephone 5032312641
Fax 5032311654
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Counselor - Addiction (Substance Use Disorder) in Gresham, OR

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 11.1 Yrs
Regional Practice Density
83 Specialists

Practicing in Gresham, OR (4216 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2026-08-03
Counselor - Addiction (Substance Use Disorder) Primary Specialty

NUCC Taxonomy Code: 101YA0400X

State License OR 00-11-45

Definition to come...

Social Worker - Clinical

NUCC Taxonomy Code: 1041C0700X

State License OR A11750

A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

Counselor - Mental Health

NUCC Taxonomy Code: 101YM0800X

State License OR 24-QMHPC-001514

Definition to come...

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
500800849 (OR)
Medicaid State Provider ID
500801135 (OR)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Donna Turquoise , QMHP-C

Counselor - Mental Health

NPI 1003103359

QMHPC

Amber Lewis , CRM, PSS

Counselor - Addiction (Substance Use Disorder)

NPI 1003450248
Deanna Shields , CADC-R, CRM, PSS

Counselor - Addiction (Substance Use Disorder)

NPI 1003592759

CADCR, CRM, PSS

Jessica Spain , CADC I, QMHA-R

Counselor - Addiction (Substance Use Disorder)

NPI 1013430271

CADCI, QMHAR

Tara Walker , QMHP, MS

Counselor - Mental Health

NPI 1013471549

Qualified Mental Health Professional, Master of Science

Nicole Williams , CADC II, QMHA-I

Counselor - Mental Health

NPI 1013560713

CADCII, QMHAI

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

15 Historical Events
👤
Provider Name / Credentials Updated August 03, 2026

Recorded as JACK JOHNSON, CADC II/QMHP-C, CSWA

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 03, 2026

Counselor (License #00-11-45 in OR)

📍
Updated Practice Location January 30, 2025

Registered at 355 NW DIVISION ST, GRESHAM, OR 970305523 (Tel: 5032312641)

👤
Provider Name / Credentials Updated January 30, 2025

Recorded as JACKIE JOHNSON, CADC II/QMHP-C, CSWA

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) January 30, 2025

Counselor (License #17-CRM-078 in OR)

📍
Updated Practice Location May 22, 2023

Registered at 1631 SW COUMBIA ST, PORTLAND, OR 97201 (Tel: 5032312641)

📍
Updated Business Mailing Address May 22, 2023

Registered at 1776 SW MADISON ST, PORTLAND, OR 972051715 (Tel: 5032241044)

👤
Provider Name / Credentials Updated May 22, 2023

Recorded as JACKIE JOHNSON, CADC II/QMHP-R

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) May 22, 2023

Counselor (License #21-QMHP-R-0965 in OR)

NPI Profile Active July 28, 2011

NPI status registered as active in NPPES database

📍
Updated Practice Location July 28, 2011

Registered at 1020 SW TAYLOR ST STE 650, PORTLAND, OR 972052506 (Tel: 5033453370)

📍
Updated Business Mailing Address July 28, 2011

Registered at 1020 SW TAYLOR ST STE 650, PORTLAND, OR 972052506 (Tel: 5033453370)

👤
Provider Name / Credentials Updated July 28, 2011

Recorded as JACKIE JOHNSON, MSW, CADC II

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 28, 2011

Counselor (License #00-11-45 in OR)

🟢
Initial NPI Registration & Enumeration June 25, 2008

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1770745457
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 25, 2008
Last Update: August 03, 2026
Sole Proprietor: No

Mailing Address

1776 Sw Madison St

Portland, OR 972051715

Phone: 5032241044

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.