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General NPI Number Information
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NPI Number | 1942683669
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Entity Type | Organization
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Legal Business Name | JOURNEY COUNSELING, LLC
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 02/04/2023
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Provider Practice Location Address
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Address Line | 1001 TWELVE OAKS CENTER DR STE 1030D
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City | WAYZATA
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State | MN
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Zip | 55391-4320
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Country | US
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Telephone | 952-224-4862
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Fax | 952-224-4862
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Provider Business Mailing Address
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Address Line | 10217 CRESTRIDGE DR
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City | MINNETONKA
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State | MN
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Zip | 55305-1605
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Country | US
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Telephone | 952-412-4490
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Fax | 952-224-4862
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Authorized Official
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Title or Position | SOLE OWNER AND PROVIDER
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Name | VIAN MAUREEN GREDVIG
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Credential |
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Telephone | 952-224-4862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6577
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License Number State | MN
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