Provider Demographics
NPI:1386187516
Name:COLLABORATIVE JOURNEY COUNSELING, LLC
Entity Type:Organization
Organization Name:COLLABORATIVE JOURNEY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMMERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:608-477-1484
Mailing Address - Street 1:314 ASH ST
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-2507
Mailing Address - Country:US
Mailing Address - Phone:608-477-1484
Mailing Address - Fax:608-356-2136
Practice Address - Street 1:314 ASH ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-2507
Practice Address - Country:US
Practice Address - Phone:608-477-1484
Practice Address - Fax:608-356-2136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-20
Last Update Date:2016-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1038-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty