Provider Demographics
NPI:1518522242
Name:JOURNEY TO A TRAUMA-INFORMED LIFE
Entity Type:Organization
Organization Name:JOURNEY TO A TRAUMA-INFORMED LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:KOEHLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:814-397-7480
Mailing Address - Street 1:201 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1701
Mailing Address - Country:US
Mailing Address - Phone:814-397-7480
Mailing Address - Fax:814-315-9564
Practice Address - Street 1:201 W 11TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1701
Practice Address - Country:US
Practice Address - Phone:814-397-7480
Practice Address - Fax:814-315-9564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)