Provider Demographics
NPI:1942683669
Name:JOURNEY COUNSELING, LLC
Entity Type:Organization
Organization Name:JOURNEY COUNSELING, LLC
Other - Org Name:VIAN M GREDVIG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:VIAN
Authorized Official - Middle Name:MAUREEN
Authorized Official - Last Name:GREDVIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-224-4862
Mailing Address - Street 1:10217 CRESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1605
Mailing Address - Country:US
Mailing Address - Phone:952-412-4490
Mailing Address - Fax:952-224-4862
Practice Address - Street 1:1001 TWELVE OAKS CENTER DR STE 1030D
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-4320
Practice Address - Country:US
Practice Address - Phone:952-224-4862
Practice Address - Fax:952-224-4862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN65771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1942246806OtherNPI 1
MN1942683669OtherNPI 2
MN1942683669Medicaid
MN1942246806Medicaid