Provider Demographics
NPI:1922818830
Name:JOHNS, BOBBY CORDELL JR (LCDCI)
Entity type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:CORDELL
Last Name:JOHNS
Suffix:JR
Gender:M
Credentials:LCDCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:208 GRASSLANDS TRL
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-2172
Mailing Address - Country:US
Mailing Address - Phone:512-629-8326
Mailing Address - Fax:
Practice Address - Street 1:8500 SHOAL CREEK BLVD STE 114
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-7591
Practice Address - Country:US
Practice Address - Phone:512-763-2565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61122101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)