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General NPI Number Information
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NPI Number | 1679091904
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Entity Type | Organization
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Legal Business Name | LIFE JOURNEY COUNSELING AND CONSULTING, LLC
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Dates
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Enumeration Date | 09/07/2017
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 11537 LAKE UNDERHILL RD
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City | ORLANDO
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State | FL
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Zip | 32825-5001
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Country | US
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Telephone | 407-821-3098
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Fax |
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Provider Business Mailing Address
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Address Line | 11537 LAKE UNDERHILL RD
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City | ORLANDO
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State | FL
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Zip | 32825-5001
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Country | US
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Telephone | 407-821-3098
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Fax | 407-821-3098
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Authorized Official
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Title or Position | CEO
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Name | MS. SHERRY STAPP MATTOS
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Credential | LMHC
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Telephone | 407-821-3098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH7519
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License Number State | FL
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