Healthcare Provider Details

I. General information

NPI: 1851859755
Provider Name (Legal Business Name): JOURNEY TO DISCOVERY COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2019
Last Update Date: 03/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 PEARL ST STE 4B
EUGENE OR
97401-3642
US

IV. Provider business mailing address

88099 LINDSAY LN
VENETA OR
97487-9698
US

V. Phone/Fax

Practice location:
  • Phone: 541-393-2280
  • Fax: 541-575-8821
Mailing address:
  • Phone: 541-393-2280
  • Fax: 541-575-8821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LORI ANN WILSON
Title or Position: SOLE MEMBER
Credential: LCSW
Phone: 541-606-7390