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General NPI Number Information
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NPI Number | 1326242827
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Entity Type | Organization
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Legal Business Name | MIDWEST JOURNEYS LLC
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 2142A WASHTENAW RD
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City | YPSILANTI
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State | MI
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Zip | 48197-1708
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Country | US
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Telephone | 734-829-0075
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3193
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City | ANN ARBOR
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State | MI
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Zip | 48106-3193
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Country | US
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Telephone | 734-829-0075
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Fax |
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Authorized Official
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Title or Position | PROGRAM AND CLINICAL DIRECTOR
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Name | MS. ROXANNA DUNTLEY-MATOS
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Credential | LMSW
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Telephone | 734-474-0792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801078742
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License Number State | MI
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