Provider Demographics
NPI:1518009547
Name:JOHNSON, BRUCE (CMSW)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:CMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 LEIGHTON LN
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-5708
Mailing Address - Country:US
Mailing Address - Phone:901-829-2328
Mailing Address - Fax:901-829-2328
Practice Address - Street 1:7410 MEMPHIS ARLINGTON RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38135-1908
Practice Address - Country:US
Practice Address - Phone:901-252-7850
Practice Address - Fax:901-252-7880
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical