Provider Demographics
NPI:1174793368
Name:JOHNS, REX WILLIAM (MED, LCPC)
Entity type:Individual
Prefix:MR
First Name:REX
Middle Name:WILLIAM
Last Name:JOHNS
Suffix:
Gender:M
Credentials:MED, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 BAXTER RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-3281
Mailing Address - Country:US
Mailing Address - Phone:907-348-7782
Mailing Address - Fax:
Practice Address - Street 1:2240 BAXTER RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-3281
Practice Address - Country:US
Practice Address - Phone:907-348-7782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKLPC-541101YM0800X
IDLCPC-164101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health