Healthcare Provider Details

I. General information

NPI: 1124990692
Provider Name (Legal Business Name): JOURNEY TOGETHER COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 WASHINGTON AVE STE 22D
DETROIT LAKES MN
56501-3068
US

IV. Provider business mailing address

808 WASHINGTON AVE STE 22D
DETROIT LAKES MN
56501-3068
US

V. Phone/Fax

Practice location:
  • Phone: 218-849-7524
  • Fax: 218-203-0441
Mailing address:
  • Phone: 218-849-7524
  • Fax: 218-203-0441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA JEAN LONGTINE
Title or Position: OWNER/COUNSELOR
Credential: LPCC
Phone: 218-849-7524