Provider Demographics
NPI:1356822910
Name:JOURNEY COUNSELING CENTER
Entity Type:Organization
Organization Name:JOURNEY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HANING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-532-0664
Mailing Address - Street 1:4747 S GOLD RD
Mailing Address - Street 2:
Mailing Address - City:BATTLEFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65619-9503
Mailing Address - Country:US
Mailing Address - Phone:417-830-3753
Mailing Address - Fax:
Practice Address - Street 1:4747 S GOLD RD
Practice Address - Street 2:
Practice Address - City:BATTLEFIELD
Practice Address - State:MO
Practice Address - Zip Code:65619-9503
Practice Address - Country:US
Practice Address - Phone:417-532-0664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1780911735Medicaid