Healthcare Provider Details

I. General information

NPI: 1922590694
Provider Name (Legal Business Name): SOUL'S JOURNEY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 08/06/2022
Certification Date: 08/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 MEDINA RD STE 101C
MEDINA OH
44256-5965
US

IV. Provider business mailing address

PO BOX 561
SHARON CENTER OH
44274-0561
US

V. Phone/Fax

Practice location:
  • Phone: 330-975-0079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE1800546
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE1800546
License Number StateOH

VIII. Authorized Official

Name: BEVERLY R MAJOR
Title or Position: OWNER
Credential: LPCC
Phone: 330-819-0792