Provider Demographics
NPI:1629136973
Name:JOURNEYS COUNSELING ASSOC INC
Entity Type:Organization
Organization Name:JOURNEYS COUNSELING ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:K
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-872-2100
Mailing Address - Street 1:PO BOX 0361
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52733-0361
Mailing Address - Country:US
Mailing Address - Phone:563-242-5316
Mailing Address - Fax:563-242-3128
Practice Address - Street 1:1405 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356
Practice Address - Country:US
Practice Address - Phone:815-872-2100
Practice Address - Fax:563-242-3128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL00623783OtherBC BS
IL00623783OtherBC BS