MEDICARE: JOURNEY COMMUNITY SERVICES 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

General Provider Information

NPI Number	:	1518537901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOURNEY COMMUNITY SERVICES LLC

Provider Business Mailing Address
First Line	:	3221 71ST ST E
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-2552
Country	:	US
Telephone Number	:	612-250-6726
Fax Number	:

Provider Business Practice Location Address
First Line	:	3221 71ST ST E
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-2552
Country	:	US
Telephone Number	:	612-250-6726
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHAMAERA SOWELL
Credential	:	LICSW
Telephone Number	:	612-250-6726

Provider Enumeration Date	:	06/28/2021
Last Update Date	:	06/28/2021

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