MEDICARE: MR. REX WILLIAM JOHNS MED, LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC-541	AK
2	101YM0800X	Mental Health Counselor	LCPC-164	ID

General Provider Information

NPI Number	:	1174793368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. REX WILLIAM JOHNS MED, LCPC

Provider Business Mailing Address
First Line	:	2240 BAXTER RD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-3281
Country	:	US
Telephone Number	:	907-348-7782
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 BAXTER RD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-3281
Country	:	US
Telephone Number	:	907-348-7782
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2008
Last Update Date	:	03/04/2008

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