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General NPI Number Information
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NPI Number | 1225788896
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Entity Type | Organization
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Legal Business Name | JOURNEY COUNSELING AND WELLNESS SERVICES LLC
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Dates
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Enumeration Date | 03/26/2022
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Last Update Date | 03/26/2022
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Provider Practice Location Address
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Address Line | 13110 SHAKER SQ # C200-E
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City | CLEVELAND
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State | OH
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Zip | 44120-2373
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Country | US
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Telephone | 216-201-9696
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Fax |
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Provider Business Mailing Address
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Address Line | 12600 ROCKSIDE RD # 303
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City | GARFIELD HEIGHTS
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State | OH
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Zip | 44125-4525
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Country | US
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Telephone | 216-543-1194
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EGYPT BURGE
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Credential | LPCC
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Telephone | 216-543-1194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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