Provider Demographics
NPI:1225788896
Name:JOURNEY COUNSELING AND WELLNESS SERVICES LLC
Entity Type:Organization
Organization Name:JOURNEY COUNSELING AND WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EGYPT
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:216-543-1194
Mailing Address - Street 1:12600 ROCKSIDE RD # 303
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-4525
Mailing Address - Country:US
Mailing Address - Phone:216-543-1194
Mailing Address - Fax:
Practice Address - Street 1:13110 SHAKER SQ # C200-E
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-2373
Practice Address - Country:US
Practice Address - Phone:216-201-9696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-26
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty