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General NPI Number Information
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NPI Number | 1013725985
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Entity Type | Organization
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Legal Business Name | SOUL JOURNEY FAMILY COUNSELING ORG
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Dates
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Enumeration Date | 12/24/2024
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Last Update Date | 12/24/2024
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Provider Practice Location Address
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Address Line | 18484 U.S.HWY 18
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City | APPLE VALLEY
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State | CA
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Zip | 92307
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Country | US
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Telephone | 530-443-3828
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Fax |
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Provider Business Mailing Address
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Address Line | 25885 SANTA ROSA RD
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City | APPLE VALLEY
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State | CA
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Zip | 92308-0462
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Country | US
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Telephone | 530-443-3828
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PENNE M LA RUE
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Credential | LMFT
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Telephone | 530-443-3828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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