Provider Demographics
NPI:1174296495
Name:LIFE'S A JOURNEY COUNSELING SERVICES
Entity Type:Organization
Organization Name:LIFE'S A JOURNEY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:541-981-8637
Mailing Address - Street 1:27744 SCOTT MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SWEET HOME
Mailing Address - State:OR
Mailing Address - Zip Code:97386-9729
Mailing Address - Country:US
Mailing Address - Phone:541-981-8637
Mailing Address - Fax:
Practice Address - Street 1:355 HIGH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3613
Practice Address - Country:US
Practice Address - Phone:541-237-7768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health