Healthcare Provider Details

I. General information

NPI: 1447407564
Provider Name (Legal Business Name): JOURNEY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#1 RAILROAD DRIVE
HIGH ROLLS NM
88325
US

IV. Provider business mailing address

PO BOX 201 #1 RAILROAD DRIVE
HIGH ROLLS NM
88325
US

V. Phone/Fax

Practice location:
  • Phone: 575-682-8178
  • Fax: 575-682-8178
Mailing address:
  • Phone: 575-682-8178
  • Fax: 575-682-8178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number0115601
License Number StateNM

VIII. Authorized Official

Name: MRS. SHEREL JO STONE
Title or Position: EXECUTIVE OFFICER
Credential: MS, LMFT
Phone: 575-682-8178