=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285491795
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MYJOURNEY COUNSELING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2024
-----------------------------------------------------
Last Update Date | 03/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 98 LONGVIEW DR
-----------------------------------------------------
City | VICTORIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77904-4710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-655-6354
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 98 LONGVIEW DR
-----------------------------------------------------
City | VICTORIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77904-4710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-578-9365
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LPC OWNER
-----------------------------------------------------
Name | MRS. MONICA HODGE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 361-655-6354
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------