Healthcare Provider Details

I. General information

NPI: 1831883859
Provider Name (Legal Business Name): JOURNEY 2 WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 SISKIYOU BLVD
ASHLAND OR
97520-2400
US

IV. Provider business mailing address

3557 JUANIPERO WAY
MEDFORD OR
97504-4319
US

V. Phone/Fax

Practice location:
  • Phone: 541-920-0817
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: CHRISTY IVORY
Title or Position: THERAPIST
Credential: LPC
Phone: 541-920-0817