Provider Demographics
NPI:1558677856
Name:JOURNEY MENTAL HEALTH SERVICES PLC
Entity Type:Organization
Organization Name:JOURNEY MENTAL HEALTH SERVICES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKESH
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:320-864-4109
Mailing Address - Street 1:1110 GREELEY AVE N
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:MN
Mailing Address - Zip Code:55336-2101
Mailing Address - Country:US
Mailing Address - Phone:320-864-4109
Mailing Address - Fax:320-864-4676
Practice Address - Street 1:1110 GREELEY AVE N
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:MN
Practice Address - Zip Code:55336-2101
Practice Address - Country:US
Practice Address - Phone:320-864-4109
Practice Address - Fax:320-864-4676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3932333-2101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty