Provider Demographics
NPI:1114796612
Name:JOURNEY TO SERENITY
Entity Type:Organization
Organization Name:JOURNEY TO SERENITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:ZACIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-332-2918
Mailing Address - Street 1:429 E VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3690
Mailing Address - Country:US
Mailing Address - Phone:317-795-4067
Mailing Address - Fax:949-695-2782
Practice Address - Street 1:429 E VERMONT ST STE L019
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3690
Practice Address - Country:US
Practice Address - Phone:317-795-4067
Practice Address - Fax:949-695-2782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty