Healthcare Provider Details

I. General information

NPI: 1346164423
Provider Name (Legal Business Name): JOURNEY WITHIN COUNSELING AND WELLNESS CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4003 80TH ST STE 103B
KENOSHA WI
53142-4995
US

IV. Provider business mailing address

4003 80TH ST STE 103B
KENOSHA WI
53142-4995
US

V. Phone/Fax

Practice location:
  • Phone: 262-725-1686
  • Fax:
Mailing address:
  • Phone: 262-725-1686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KELLY ELIZABETH SEIN
Title or Position: CLINICAL THERAPIST
Credential: LCSW
Phone: 262-725-1686