Provider Demographics
NPI:1598120917
Name:JOURNEY MENTAL HEALTH, INC.
Entity Type:Organization
Organization Name:JOURNEY MENTAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:208-921-4129
Mailing Address - Street 1:3288 E PINE AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5922
Mailing Address - Country:US
Mailing Address - Phone:208-921-4129
Mailing Address - Fax:208-658-0153
Practice Address - Street 1:3288 E PINE AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5922
Practice Address - Country:US
Practice Address - Phone:208-921-4129
Practice Address - Fax:208-658-0153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5520251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health