Provider Demographics
NPI:1639946098
Name:JOURNEY WITHIN CHRISTIAN COUNSELING, LLC
Entity Type:Organization
Organization Name:JOURNEY WITHIN CHRISTIAN COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DOMAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-297-6680
Mailing Address - Street 1:11414 W PARK PL
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-3500
Mailing Address - Country:US
Mailing Address - Phone:262-297-6680
Mailing Address - Fax:262-364-2742
Practice Address - Street 1:11414 W PARK PL
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-3500
Practice Address - Country:US
Practice Address - Phone:262-297-6680
Practice Address - Fax:262-364-2742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health