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General NPI Number Information
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NPI Number | 1336911528
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Entity Type | Organization
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Legal Business Name | JOURNEY TO SERENITY LLC
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Dates
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Enumeration Date | 10/23/2023
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 5222 OAK ROW
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City | MARRERO
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State | LA
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Zip | 70072-7662
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Country | US
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Telephone | 504-344-0329
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Fax |
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Provider Business Mailing Address
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Address Line | 5222 OAK ROW
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City | MARRERO
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State | LA
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Zip | 70072-7662
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Country | US
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Telephone | 504-344-0329
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | SHELLY WILLIAMS
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Credential |
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Telephone | 504-344-0329
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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