Provider Demographics
NPI:1528392149
Name:SONGS OF THE JOURNEY COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:SONGS OF THE JOURNEY COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:H.
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-287-9913
Mailing Address - Street 1:2900 FREMONT AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-1313
Mailing Address - Country:US
Mailing Address - Phone:612-287-9913
Mailing Address - Fax:612-287-9914
Practice Address - Street 1:2900 FREMONT AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-1313
Practice Address - Country:US
Practice Address - Phone:612-287-9913
Practice Address - Fax:612-287-9914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN128061041C0700X
MN43991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1154542454Medicaid
MN1144216532Medicaid