Provider Demographics
NPI:1811386618
Name:JOURNEY MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:JOURNEY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR BUSINESS DEVELOP
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEITZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-280-2695
Mailing Address - Street 1:25 KESSEL CT
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6227
Mailing Address - Country:US
Mailing Address - Phone:608-280-2700
Mailing Address - Fax:608-280-2704
Practice Address - Street 1:1320 MENDOTA ST
Practice Address - Street 2:SUITE 106
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-1096
Practice Address - Country:US
Practice Address - Phone:608-280-2700
Practice Address - Fax:608-280-2704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-16
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1598251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43422200Medicaid