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General NPI Number Information
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NPI Number | 1053009449
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Entity Type | Organization
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Legal Business Name | JOURNEY HOUSE INTERNATIONAL CENTER LLC
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Dates
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Enumeration Date | 04/25/2023
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 8032 22ND AVE # 5151
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City | KENOSHA
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State | WI
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Zip | 53143-6208
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Country | US
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Telephone | 262-289-4378
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Fax | 262-288-4353
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Provider Business Mailing Address
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Address Line | 8032 22ND AVE # 5151
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City | KENOSHA
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State | WI
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Zip | 53143-6208
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Country | US
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Telephone | 262-289-4378
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Fax | 262-288-4353
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | LORICE JEAN
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Credential | LPC, CSAC, ICS
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Telephone | 262-822-6847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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