Healthcare Provider Details

I. General information

NPI: 1740988971
Provider Name (Legal Business Name): PEACEFUL JOURNEY COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 03/05/2023
Certification Date: 03/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 LAUREL DR
JEFFERSON TWP PA
18436-3462
US

IV. Provider business mailing address

331 LAUREL DR
JEFFERSON TWP PA
18436-3462
US

V. Phone/Fax

Practice location:
  • Phone: 570-634-5526
  • Fax:
Mailing address:
  • Phone: 570-634-5526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
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: ERIC MCNEISH
Title or Position: OWNER
Credential: MS, NCC, LPC
Phone: 570-634-5526