Provider Demographics
NPI:1891959318
Name:JOURNEY TO NEW BEGINNINGS, PLLC
Entity Type:Organization
Organization Name:JOURNEY TO NEW BEGINNINGS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHACHTERLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:662-349-2979
Mailing Address - Street 1:5627 GETWELL RD
Mailing Address - Street 2:BUILDING B SUITE 4
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-7313
Mailing Address - Country:US
Mailing Address - Phone:662-349-2979
Mailing Address - Fax:662-349-2978
Practice Address - Street 1:5627 GETWELL RD
Practice Address - Street 2:BUILDING B SUITE 4
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-7313
Practice Address - Country:US
Practice Address - Phone:662-349-2979
Practice Address - Fax:662-349-2978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01326356Medicaid