Provider Demographics
NPI:1255881801
Name:JOHNSON, ROBERT ELIAS (LPC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ELIAS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 W SUNSHINE ST # 209
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-2344
Mailing Address - Country:US
Mailing Address - Phone:417-242-1493
Mailing Address - Fax:417-304-2920
Practice Address - Street 1:1531 E BRADFORD PKWY STE 300
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6539
Practice Address - Country:US
Practice Address - Phone:172-421-4934
Practice Address - Fax:417-304-2920
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016006115101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional