Provider Demographics
NPI:1033510391
Name:THE JOURNEY RESOURCE CENTER
Entity Type:Organization
Organization Name:THE JOURNEY RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:662-760-0115
Mailing Address - Street 1:30 COUNTY ROAD 7051
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-7517
Mailing Address - Country:US
Mailing Address - Phone:662-760-0115
Mailing Address - Fax:662-489-7298
Practice Address - Street 1:114 E BOLTON ST
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-1506
Practice Address - Country:US
Practice Address - Phone:660-760-0115
Practice Address - Fax:662-489-7298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1923101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1923OtherCOUNSELOR