Basic Information
| Provider Information | |||||||||
| NPI: | 1881722494 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNS | ||||||||
| FirstName: | REX | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PHD, LPC,LAC, NCC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | JOHNS | ||||||||
| OtherFirstName: | R. DAVID | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5290 DTC PKWY STE 150 | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801112764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036426636 | ||||||||
| FaxNumber: | 3034325018 | ||||||||
| Practice Location | |||||||||
| Address1: | 5290 DTC PKWY STE 150 | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801112764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036426636 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 03/31/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 222769 | CO | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | 5317 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.