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General NPI Number Information
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NPI Number | 1336295757
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Entity Type | Organization
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Legal Business Name | JOURNEY WORKS, LTD.
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 01/20/2011
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Provider Practice Location Address
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Address Line | 1217 MCHENRY RD 233
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-1379
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Country | US
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Telephone | 847-604-0734
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Fax | 847-793-8830
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Provider Business Mailing Address
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Address Line | 1217 MCHENRY RD 233
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-1379
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Country | US
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Telephone | 847-604-0734
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Fax | 847-793-8830
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KIRK WAYNE ERICKSON
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Credential | PSY.D.
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Telephone | 847-604-0734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071004736
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License Number State | IL
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