MEDICARE: JOURNEY THROUGH LIFE TX LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	251B00000X	Case Management Agency		TX

General Provider Information

NPI Number	:	1316300908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOURNEY THROUGH LIFE TX LLC

Provider Business Mailing Address
First Line	:	5974 MYAKKA CT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-3265
Country	:	US
Telephone Number	:	919-758-3082
Fax Number	:	225-590-3324

Provider Business Practice Location Address
First Line	:	7151 OFFICE CITY DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087
Country	:	US
Telephone Number	:	919-758-3082
Fax Number	:	919-809-8642

Authorized Official
Title or Position	:	CEO
Name	:	MRS. MARIE N LAURENT
Credential	:	LCSW
Telephone Number	:	919-758-3082

Provider Enumeration Date	:	03/31/2016
Last Update Date	:	07/17/2018

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