Provider Demographics
NPI:1386202091
Name:JOURNEYS: A PATHWAY /TO HEALING, LLC
Entity Type:Organization
Organization Name:JOURNEYS: A PATHWAY /TO HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:D'UNDRA
Authorized Official - Middle Name:RYNISE
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:612-412-4819
Mailing Address - Street 1:625 SNELLING AVE N # 5
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2878
Mailing Address - Country:US
Mailing Address - Phone:612-412-4819
Mailing Address - Fax:
Practice Address - Street 1:625 SNELLING AVE N # 5
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2878
Practice Address - Country:US
Practice Address - Phone:612-412-4819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty