DR. CLIFFORD ALAN JOHANNSEN (PH.D.) – Group Psychotherapy Psychologist, NPI 1962627901
Group Psychotherapy Psychologist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
647 CLINICAL PSYCHOLOGIST in OR
Provider Addresses for DR. CLIFFORD ALAN JOHANNSEN (PH.D.)
PO BOX 2004
LAKE OSWEGO, OR 970350626
Phone: (503) 246-5986
Fax: (503) 246-8050
Type: Mailing
635 CHURCH ST NE
SALEM, OR 973012402
Phone: (503) 399-9691
Fax: (503) 399-9401
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2009-01-29
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20090129000006 | I | Clinical Psychologist | OR | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 97035)
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