Provider Demographics
NPI:1831102052
Name:JOHNS, BRUCE R (PHD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:R
Last Name:JOHNS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 E 1260 N
Mailing Address - Street 2:P.O. BOX 6244
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-7501
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
Practice Address - Country:US
Practice Address - Phone:435-750-6300
Practice Address - Fax:435-753-8995
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT113318-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107005537101OtherSELECT HEALTH INSURANCES
UT43398OtherPEHP INSURANCES
UT870621744JO2OtherEMIA INSURANCES
UT20965OtherDMBA INSURANCE
UT870621744JO2OtherEMIA INSURANCES
UT43398OtherPEHP INSURANCES