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General NPI Number Information
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NPI Number | 1427351402
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Entity Type | Organization
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Legal Business Name | JOURNEY THROUGH LIFE COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 12/13/2010
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Provider Practice Location Address
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Address Line | 412 N FRANKLIN ST
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City | CUBA
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State | MO
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Zip | 65453-1719
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Country | US
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Telephone | 573-885-1600
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Fax | 573-885-1600
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Provider Business Mailing Address
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Address Line | 404 MAGNOLIA ST
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City | CUBA
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State | MO
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Zip | 65453-1924
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Country | US
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Telephone | 573-885-1600
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Fax | 573-885-1600
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Authorized Official
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Title or Position | OWNER/LICENSED THERAPIST
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Name | MS. BONITA LYNNE WALDNER
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Credential | LCSW
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Telephone | 573-885-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #4
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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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