MEDICARE: YOUR JOURNEY TO HEALING, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1548957863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR JOURNEY TO HEALING, PLLC

Provider Business Mailing Address
First Line	:	1660 S UNIVERSITY DR # 1102
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6524
Country	:	US
Telephone Number	:	469-454-0894
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 S UNIVERSITY DR # 1102
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6524
Country	:	US
Telephone Number	:	469-454-0894
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	VARISSA OWENS
Credential	:	MA, LPC, NCC
Telephone Number	:	469-454-0894

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	04/18/2023

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