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General NPI Number Information
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NPI Number | 1922818830
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Entity Type | Individual
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Provider Name | BOBBY CORDELL JOHNS JR. LCDCI
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Gender | Male
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 8500 SHOAL CREEK BLVD STE 114
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City | AUSTIN
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State | TX
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Zip | 78757-7591
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Country | US
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Telephone | 512-763-2565
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Fax |
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Provider Business Mailing Address
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Address Line | 208 GRASSLANDS TRL
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City | HUTTO
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State | TX
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Zip | 78634-2172
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Country | US
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Telephone | 512-629-8326
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 61122
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License Number State | TX
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