Healthcare Provider Details

I. General information

NPI: 1194297788
Provider Name (Legal Business Name): INNER JOURNEY COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 05/20/2023
Certification Date: 05/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6412 US HIGHWAY 27 S
SEBRING FL
33876-5711
US

IV. Provider business mailing address

6412 US HIGHWAY 27 S
SEBRING FL
33876-5711
US

V. Phone/Fax

Practice location:
  • Phone: 863-991-3232
  • Fax:
Mailing address:
  • Phone: 863-991-3232
  • Fax: 866-634-3605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. EVELYN DEJESUS
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 863-991-3232