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General NPI Number Information
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NPI Number | 1053839837
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Entity Type | Organization
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Legal Business Name | A GENTLE JOURNEY CORPORATION
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 1305 E MAIN ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-5322
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Country | US
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Telephone | 479-518-4674
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Fax | 479-308-0266
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Provider Business Mailing Address
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Address Line | 363 SAGEWOOD LN
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City | RUSSELLVILLE
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State | AR
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Zip | 72802-6918
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHERRY BOWLEY
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Credential | LPC-S
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Telephone | 479-518-4674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | P1705309
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | P1705309
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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