Healthcare Provider Details

I. General information

NPI: 1427640861
Provider Name (Legal Business Name): JOURNEYS OUTPATIENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 W WATER ST
TOMS RIVER NJ
08753-6693
US

IV. Provider business mailing address

313 W WATER ST
TOMS RIVER NJ
08753-6693
US

V. Phone/Fax

Practice location:
  • Phone: 732-300-6840
  • Fax: 732-333-6841
Mailing address:
  • Phone: 732-300-6840
  • Fax: 732-333-6841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA PROSPERI
Title or Position: CHIEF OPERATING OFFICER
Credential: ACHE,ATSA
Phone: 732-333-6840