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General NPI Number Information
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NPI Number | 1154976637
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Entity Type | Organization
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Legal Business Name | ALONG YOUR JOURNEY, LLC
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Dates
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Enumeration Date | 08/01/2019
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 423 MAIN ST STE 300
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City | FORT MORGAN
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State | CO
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Zip | 80701-2154
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Country | US
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Telephone | 720-443-0406
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Fax | 877-604-4088
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Provider Business Mailing Address
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Address Line | PO BOX 1132
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City | FORT MORGAN
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State | CO
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Zip | 80701-1132
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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 | MENTAL HEALTH PROVIDER / OWNER
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Name | SHANNONELAINE S JOHN
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Credential |
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Telephone | 720-443-0406
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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 | 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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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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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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