Provider Demographics
NPI:1619325164
Name:JOURNEY OF GRACE COUNSELING LLC
Entity Type:Organization
Organization Name:JOURNEY OF GRACE COUNSELING LLC
Other - Org Name:JOURNEY OF GRACE
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BONGERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:920-750-6120
Mailing Address - Street 1:2636 W SUNNYVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-1164
Mailing Address - Country:US
Mailing Address - Phone:920-750-6120
Mailing Address - Fax:920-750-6121
Practice Address - Street 1:5497 W WATERFORD LN
Practice Address - Street 2:SUITE A
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8509
Practice Address - Country:US
Practice Address - Phone:920-750-6120
Practice Address - Fax:920-750-6121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5970-125251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health