Healthcare Provider Details

I. General information

NPI: 1124915178
Provider Name (Legal Business Name): INNER JOURNEY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17019 N STATE HIGHWAY 5 STE C1
SUNRISE BEACH MO
65079-7034
US

IV. Provider business mailing address

17019 N STATE HIGHWAY 5 STE C1
SUNRISE BEACH MO
65079-7034
US

V. Phone/Fax

Practice location:
  • Phone: 660-595-1446
  • Fax:
Mailing address:
  • Phone: 573-692-2988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AMBER DAWN JOHNSON
Title or Position: OWNER
Credential: LCSW
Phone: 573-480-7189