Provider Demographics
NPI:1710635388
Name:JOURNEY OF HOPE AND COURAGE LLC
Entity Type:Organization
Organization Name:JOURNEY OF HOPE AND COURAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:INTERIAL
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-595-7093
Mailing Address - Street 1:1380 RIO RANCHO BLVD
Mailing Address - Street 2:#107
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124
Mailing Address - Country:US
Mailing Address - Phone:505-595-7093
Mailing Address - Fax:
Practice Address - Street 1:712 SARATOGA DR NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4624
Practice Address - Country:US
Practice Address - Phone:505-595-7093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty