Provider Demographics
NPI:1811581739
Name:JOURNEY MENTAL HEALTH
Entity Type:Organization
Organization Name:JOURNEY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TALESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEGER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:701-315-0456
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:UNDERWOOD
Mailing Address - State:ND
Mailing Address - Zip Code:58576-0602
Mailing Address - Country:US
Mailing Address - Phone:701-737-9726
Mailing Address - Fax:701-253-1834
Practice Address - Street 1:302 2ND STREET
Practice Address - Street 2:
Practice Address - City:UNDERWOOD
Practice Address - State:ND
Practice Address - Zip Code:58576-5857
Practice Address - Country:US
Practice Address - Phone:701-737-9726
Practice Address - Fax:701-253-1834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty