Provider Demographics
NPI:1003418435
Name:KANGAROO JOURNEYS LLC
Entity Type:Organization
Organization Name:KANGAROO JOURNEYS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:JARED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-404-8686
Mailing Address - Street 1:859 FORTUNEGATE DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3521
Mailing Address - Country:US
Mailing Address - Phone:614-404-8686
Mailing Address - Fax:
Practice Address - Street 1:859 FORTUNEGATE DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3521
Practice Address - Country:US
Practice Address - Phone:614-404-8686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1952670739OtherPRIVATE INSURANCE