Provider Demographics
NPI:1598216731
Name:BRUCE R. JOHNS, PH.D., P.C.
Entity Type:Organization
Organization Name:BRUCE R. JOHNS, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:435-750-6300
Mailing Address - Street 1:PO BOX 6244
Mailing Address - Street 2:PO BOX 6244
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-6244
Mailing Address - Country:US
Mailing Address - Phone:435-750-6300
Mailing Address - Fax:435-753-8995
Practice Address - Street 1:246 E 1260, N
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-6244
Practice Address - Country:US
Practice Address - Phone:435-750-6300
Practice Address - Fax:435-750-6300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1133182501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTR34237Medicare UPIN