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General NPI Number Information
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NPI Number | 1174296495
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Entity Type | Organization
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Legal Business Name | LIFE'S A JOURNEY COUNSELING SERVICES
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Dates
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Enumeration Date | 08/02/2021
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 355 HIGH ST SE
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City | SALEM
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State | OR
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Zip | 97301-3613
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Country | US
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Telephone | 541-237-7768
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Fax |
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Provider Business Mailing Address
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Address Line | 27744 SCOTT MOUNTAIN RD
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City | SWEET HOME
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State | OR
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Zip | 97386-9729
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Country | US
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Telephone | 541-981-8637
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MICHELLE SHANNON
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Credential | LPC
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Telephone | 541-981-8637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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