Provider Demographics
NPI:1598466559
Name:A MEANINGFUL JOURNEY PLLC
Entity Type:Organization
Organization Name:A MEANINGFUL JOURNEY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVYSUE
Authorized Official - Middle Name:
Authorized Official - Last Name:HRANAC
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-750-3324
Mailing Address - Street 1:60 HANSON ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-2720
Mailing Address - Country:US
Mailing Address - Phone:603-750-3246
Mailing Address - Fax:
Practice Address - Street 1:60 HANSON ST UNIT 2
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-2720
Practice Address - Country:US
Practice Address - Phone:603-750-3246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2114202Medicaid