Provider Information for 1255881801
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ROBERT ELIAS JOHNSON LPC
Sex: Male
NPI: 1255881801
Last Updated: 2023-05-05
Certification Date: 2023-05-05
Certification Date: 2023-05-05
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1255881801 | ||||||||
| Enumeration Date | 2016-10-06 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1325 W SUNSHINE ST # 209 SPRINGFIELD, MO 65807-2344 United States Phone: 417-242-1493 | Fax:417-304-2920 | ||||||||
| Primary Practice Address | 1531 E BRADFORD PKWY STE 300 SPRINGFIELD, MO 65804-6539 United States Phone: 172-421-4934 | Fax:417-304-2920 | ||||||||
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