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Individual

BRUCE JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LCP

Contact information

Practice address
2001 CLAFLIN RD, MANHATTAN, KS 66502-3415
(785) 587-4300
(785) 587-4377
Mailing address
PO BOX 747, MANHATTAN, KS 66505-0747
(785) 587-4344
(785) 587-4377

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1228
KS
103T00000X
Psychologist
Primary
225
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100106710
KS
Enumeration date
02/04/2015
Last updated
10/03/2018
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