Provider Demographics
NPI:1275987026
Name:ON A JOURNEY COUNSELING CENTER
Entity Type:Organization
Organization Name:ON A JOURNEY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARKELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-MHSP
Authorized Official - Phone:615-479-4180
Mailing Address - Street 1:709 RIVERGATE PKWY
Mailing Address - Street 2:SUITE A6
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2315
Mailing Address - Country:US
Mailing Address - Phone:615-549-5256
Mailing Address - Fax:
Practice Address - Street 1:709 RIVERGATE PKWY
Practice Address - Street 2:SUITE A6
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2315
Practice Address - Country:US
Practice Address - Phone:615-549-5256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3357251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health