=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932959871
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOURNEY'S HOLISTIC HEALTH AND HEALING ARTS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2024
-----------------------------------------------------
Last Update Date | 03/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31 OAK ST
-----------------------------------------------------
City | LORMAN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39096-5167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-807-5441
-----------------------------------------------------
Fax | 601-304-4355
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 308
-----------------------------------------------------
City | LORMAN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39096-0308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-807-5441
-----------------------------------------------------
Fax | 601-304-4355
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | MRS. BRENDA FAYE COLLINS
-----------------------------------------------------
Credential | FNP-C, PHD
-----------------------------------------------------
Telephone | 601-807-5441
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------