Provider Demographics
NPI:1851700249
Name:JOURNEY COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:JOURNEY COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-982-0948
Mailing Address - Street 1:PO BOX 59397
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39284-9397
Mailing Address - Country:US
Mailing Address - Phone:601-982-0948
Mailing Address - Fax:877-907-6577
Practice Address - Street 1:2080 DUNBARTON DR
Practice Address - Street 2:SUITE 1
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5016
Practice Address - Country:US
Practice Address - Phone:601-982-0948
Practice Address - Fax:877-907-6577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-11
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC66961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06202806Medicaid