Provider Demographics
NPI:1013725985
Name:SOUL JOURNEY FAMILY COUNSELING ORG
Entity type:Organization
Organization Name:SOUL JOURNEY FAMILY COUNSELING ORG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PENNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LA RUE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:530-443-3828
Mailing Address - Street 1:25885 SANTA ROSA RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-0462
Mailing Address - Country:US
Mailing Address - Phone:530-443-3828
Mailing Address - Fax:
Practice Address - Street 1:18484 U.S.HWY 18
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307
Practice Address - Country:US
Practice Address - Phone:530-443-3828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty