=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467283739
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINDFUL JOURNEY COUNSELING AND CONSULTING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2024
-----------------------------------------------------
Last Update Date | 12/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 902 MARKET ST
-----------------------------------------------------
City | MEADVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16335-3319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-992-0145
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 902 MARKET ST
-----------------------------------------------------
City | MEADVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16335-3319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-992-0145
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. MELISSA LEWIS
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 724-992-0145
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------