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General NPI Number Information
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NPI Number | 1811225774
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Entity Type | Organization
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Legal Business Name | BARRY JOHNSON, MSW, LCSW, LLC
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Dates
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Enumeration Date | 12/03/2009
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Last Update Date | 12/03/2009
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Provider Practice Location Address
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Address Line | 202 HAVANA ST
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City | STEELVILLE
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State | MO
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Zip | 65565-5077
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Country | US
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Telephone | 573-205-1279
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Fax |
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Provider Business Mailing Address
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Address Line | 202 HAVANA ST
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City | STEELVILLE
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State | MO
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Zip | 65565-5077
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Country | US
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Telephone | 573-205-1279
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | BARRY JOHNSON
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Credential | LCSW
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Telephone | 573-205-1279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2009032380
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License Number State | MO
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