Healthcare Provider Details

I. General information

NPI: 1164018271
Provider Name (Legal Business Name): YOUR JOURNEY COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 NW HELMHOLTZ WAY
REDMOND OR
97756-9339
US

IV. Provider business mailing address

1214 NW HELMHOLTZ WAY
REDMOND OR
97756-9339
US

V. Phone/Fax

Practice location:
  • Phone: 541-408-1084
  • Fax:
Mailing address:
  • Phone: 541-408-1084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY CORINNE STADLER
Title or Position: OWNER/PROVIDER
Credential: LPC
Phone: 541-527-5774