Provider Demographics
NPI:1578238887
Name:JOURNEY ONLINE COUNSELING PLLC
Entity Type:Organization
Organization Name:JOURNEY ONLINE COUNSELING PLLC
Other - Org Name:KELLI A. WRIGHT
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENSED CLINICAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LPCC
Authorized Official - Phone:254-749-1284
Mailing Address - Street 1:5900 BALCONES DR STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4298
Mailing Address - Country:US
Mailing Address - Phone:866-826-4057
Mailing Address - Fax:
Practice Address - Street 1:5900 BALCONES DR STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4298
Practice Address - Country:US
Practice Address - Phone:866-826-4057
Practice Address - Fax:866-826-4405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX63600OtherLPC LICENSE # IN TX
KY263084OtherLPCC