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General NPI Number Information
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NPI Number | 1831883859
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Entity Type | Organization
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Legal Business Name | JOURNEY 2 WELLNESS LLC
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 1605 SISKIYOU BLVD
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City | ASHLAND
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State | OR
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Zip | 97520-2400
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Country | US
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Telephone | 541-920-0817
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Fax |
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Provider Business Mailing Address
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Address Line | 3557 JUANIPERO WAY
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City | MEDFORD
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State | OR
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Zip | 97504-4319
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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 | THERAPIST
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Name | CHRISTY IVORY
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Credential | LPC
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Telephone | 541-920-0817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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