MEDICARE: JOURNEY COUNSELING SERVICES

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	082960571	OK

General Provider Information

NPI Number	:	1801213541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOURNEY COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	4835 S PEORIA AVE
Second Line	:	SUITE 7
City	:	TULSA
State	:	OK
Zip	:	74105-4562
Country	:	US
Telephone Number	:	405-343-3664
Fax Number	:

Provider Business Practice Location Address
First Line	:	4835 S PEORIA AVE
Second Line	:	SUITE 7
City	:	TULSA
State	:	OK
Zip	:	74105-4562
Country	:	US
Telephone Number	:	405-343-3664
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MISS ASHLEY ANN ROBERTS
Credential	:	M.S.
Telephone Number	:	405-343-3664

Provider Enumeration Date	:	03/19/2014
Last Update Date	:	03/19/2014

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