Provider Demographics
NPI:1811225774
Name:BARRY JOHNSON, MSW, LCSW, LLC
Entity Type:Organization
Organization Name:BARRY JOHNSON, MSW, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:573-205-1279
Mailing Address - Street 1:202 HAVANA ST
Mailing Address - Street 2:
Mailing Address - City:STEELVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65565-5077
Mailing Address - Country:US
Mailing Address - Phone:573-205-1279
Mailing Address - Fax:
Practice Address - Street 1:202 HAVANA ST
Practice Address - Street 2:
Practice Address - City:STEELVILLE
Practice Address - State:MO
Practice Address - Zip Code:65565-5077
Practice Address - Country:US
Practice Address - Phone:573-205-1279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009032380251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health