Provider Demographics
NPI:1275088619
Name:JOURNEY COUNSELING PLLC
Entity Type:Organization
Organization Name:JOURNEY COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:701-356-5544
Mailing Address - Street 1:222 BROADWAY N STE 206
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4770
Mailing Address - Country:US
Mailing Address - Phone:701-356-5544
Mailing Address - Fax:701-356-2005
Practice Address - Street 1:222 BROADWAY N STE 206
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4770
Practice Address - Country:US
Practice Address - Phone:701-356-5544
Practice Address - Fax:701-356-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND597-1-1-08251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health