Provider Demographics
NPI:1477190619
Name:WELLNESS JOURNEY COUNSELING AND EMBODIMENT SERVICES LLC
Entity Type:Organization
Organization Name:WELLNESS JOURNEY COUNSELING AND EMBODIMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALIHAH
Authorized Official - Middle Name:
Authorized Official - Last Name:TALIFARRO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:317-660-5538
Mailing Address - Street 1:1075 BROAD RIPPLE AVE STE 138
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2034
Mailing Address - Country:US
Mailing Address - Phone:317-660-5538
Mailing Address - Fax:
Practice Address - Street 1:740 E 52ND ST STE 10
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-1176
Practice Address - Country:US
Practice Address - Phone:317-660-5538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty