Individual
THERESA JOHNS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
331 S 3RD ST, BARDSTOWN, KY 40004-1032
(502) 348-9206
(502) 348-6485
Mailing address
107 CRANES ROOST CT, ELIZABETHTOWN, KY 42701-3650
(270) 765-2605
(270) 234-8572
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
4672
KY
1041C0700X
Clinical Social Worker
Primary
252030
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000339368
ANTHEM
KY
05
—
30605018
—
KY
Enumeration date
06/05/2006
Last updated
06/29/2016
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