MEDICARE: AUTHENTIC JOURNEY COUNSELING SERVICES, P.C.

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	001153	IA

General Provider Information

NPI Number	:	1952840316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTHENTIC JOURNEY COUNSELING SERVICES, P.C.

Provider Business Mailing Address
First Line	:	509 W SHERIDAN AVE
Second Line	:
City	:	SHENANDOAH
State	:	IA
Zip	:	51601-1705
Country	:	US
Telephone Number	:	712-520-0237
Fax Number	:	866-675-5954

Provider Business Practice Location Address
First Line	:	509 W SHERIDAN AVE
Second Line	:
City	:	SHENANDOAH
State	:	IA
Zip	:	51601-1705
Country	:	US
Telephone Number	:	712-520-0237
Fax Number	:	866-675-5954

Authorized Official
Title or Position	:	OWNER
Name	:	ETTA MURPHY
Credential	:
Telephone Number	:	712-520-0237

Provider Enumeration Date	:	02/18/2017
Last Update Date	:	04/25/2017

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