=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225362601
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOURNEY COUNSELING SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2009
-----------------------------------------------------
Last Update Date | 04/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 SMOKERISE BLVD
-----------------------------------------------------
City | LONGWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32779-3314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-446-8155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 107 SMOKERISE BLVD
-----------------------------------------------------
City | LONGWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32779-3314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-446-8155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ERIN SWENSON-REINHOLD
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 407-446-8155
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | P09000072911
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------