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General NPI Number Information
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NPI Number | 1033510391
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Entity Type | Organization
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Legal Business Name | JOURNEY RESOURCE CENTER LLC
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Dates
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Enumeration Date | 09/05/2014
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 2164 SOUTHRIDGE DR
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City | TUPELO
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State | MS
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Zip | 38801-6417
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Country | US
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Telephone | 660-760-0115
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Fax | 662-596-0428
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Provider Business Mailing Address
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Address Line | 238 COUNTY ROAD 2446
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City | GUNTOWN
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State | MS
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Zip | 38849-9106
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Country | US
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Telephone | 662-760-0115
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Fax | 662-596-0428
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KIMBERLY A KELLY
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Credential | LPC
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Telephone | 662-760-0115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1923
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License Number State | MS
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