Provider Demographics
NPI:1598549305
Name:JOURNEY OF THE PHOENIX COUNSELING, PLLC
Entity Type:Organization
Organization Name:JOURNEY OF THE PHOENIX COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VERGARA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:254-294-7669
Mailing Address - Street 1:10412 WHITNEY TRCE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-5686
Mailing Address - Country:US
Mailing Address - Phone:254-548-7143
Mailing Address - Fax:
Practice Address - Street 1:10412 WHITNEY TRCE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-5686
Practice Address - Country:US
Practice Address - Phone:254-548-7143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-22
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)