Provider Demographics
NPI:1891496907
Name:JOURNEY PSYCHOLOGY CENTER, LLC
Entity Type:Organization
Organization Name:JOURNEY PSYCHOLOGY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR & LCP
Authorized Official - Prefix:DR
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:P
Authorized Official - Last Name:KHELGHATI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-870-0330
Mailing Address - Street 1:4164 N LINCOLN AVE STE C1S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3083
Mailing Address - Country:US
Mailing Address - Phone:312-780-0330
Mailing Address - Fax:312-312-9641
Practice Address - Street 1:4164 N LINCOLN AVE STE C1S
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3083
Practice Address - Country:US
Practice Address - Phone:312-780-0330
Practice Address - Fax:312-312-9641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty