MEDICARE: A JOURNEY MADE PLLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1841016623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A JOURNEY MADE PLLC

Provider Business Mailing Address
First Line	:	PO BOX 130512
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77219-0512
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 CLEVELAND ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-5243
Country	:	US
Telephone Number	:	713-922-4996
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ASHLEY MAYNARD
Credential	:	LPC
Telephone Number	:	215-586-0580

Provider Enumeration Date	:	11/26/2024
Last Update Date	:	11/26/2024

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Directions to “A JOURNEY MADE PLLC ” Practice Location

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