Provider Demographics
NPI:1790199594
Name:JOURNEY COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:JOURNEY COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WHEATON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:605-988-8122
Mailing Address - Street 1:2525 W MAIN ST STE 214
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-2439
Mailing Address - Country:US
Mailing Address - Phone:605-988-8131
Mailing Address - Fax:605-988-8141
Practice Address - Street 1:2525 W MAIN ST STE 214
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-2439
Practice Address - Country:US
Practice Address - Phone:605-988-8131
Practice Address - Fax:605-988-8141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLMFT1212106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2016647Medicaid