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General NPI Number Information
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NPI Number | 1659029064
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Entity Type | Organization
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Legal Business Name | JOURNEY TO SELF, LLC
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Dates
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Enumeration Date | 03/15/2022
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 2816 SALMON ST
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City | PHILADELPHIA
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State | PA
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Zip | 19134-5603
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Country | US
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Telephone | 484-515-4344
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Fax |
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Provider Business Mailing Address
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Address Line | 1602 FRANKFORD AVE UNIT 3743
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City | PHILADELPHIA
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State | PA
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Zip | 19125-4432
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PART-OWNER
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Name | MS. EILEEN CATHERINE MORAN
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Credential | LPC
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Telephone | 267-391-7850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health 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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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