Provider Demographics
NPI:1184343154
Name:JOHNS, JUSTIN LEE (LCSW)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:LEE
Last Name:JOHNS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4228 S 140TH RD
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-8371
Mailing Address - Country:US
Mailing Address - Phone:417-838-5848
Mailing Address - Fax:
Practice Address - Street 1:900 E SAN MARTIN ST
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-2893
Practice Address - Country:US
Practice Address - Phone:417-501-6138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190215901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical