Provider Demographics
NPI:1184631814
Name:YOUR JOURNEY INC.
Entity Type:Organization
Organization Name:YOUR JOURNEY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLIZZARD
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:904-772-6442
Mailing Address - Street 1:9526 ARGYLE FOREST BLVD
Mailing Address - Street 2:SUITE B2 PMB #309
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-2825
Mailing Address - Country:US
Mailing Address - Phone:904-772-6442
Mailing Address - Fax:904-772-6443
Practice Address - Street 1:9447 BRUNTSFIELD DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-7176
Practice Address - Country:US
Practice Address - Phone:904-772-6442
Practice Address - Fax:904-772-6443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty