Provider Demographics
NPI:1326708819
Name:FRESH JOURNEY COUNSELING
Entity Type:Organization
Organization Name:FRESH JOURNEY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:MEJIA
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSE PROFESSIONAL
Authorized Official - Phone:209-658-5078
Mailing Address - Street 1:5180 W HIGHWAY 290 UNIT 150
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8910
Mailing Address - Country:US
Mailing Address - Phone:512-842-9876
Mailing Address - Fax:
Practice Address - Street 1:2312 WESTERN TRAILS BLVD # 204
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1642
Practice Address - Country:US
Practice Address - Phone:209-658-5078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-23
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty