Provider Demographics
NPI:1477164895
Name:JOURNEY THERAPY, LLC
Entity Type:Organization
Organization Name:JOURNEY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKBIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-964-8897
Mailing Address - Street 1:40 PHEASANT CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-9206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 PHEASANT CT
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-9206
Practice Address - Country:US
Practice Address - Phone:717-964-8897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty