Provider Demographics
NPI:1134577349
Name:JOURNEY WELL, LLC
Entity type:Organization
Organization Name:JOURNEY WELL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:ANCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC-S, LSW
Authorized Official - Phone:513-445-9959
Mailing Address - Street 1:5720 GATEWAY BLVD #204
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1891
Mailing Address - Country:US
Mailing Address - Phone:513-445-9959
Mailing Address - Fax:513-725-1276
Practice Address - Street 1:5720 GATEWAY BLVD #204
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1891
Practice Address - Country:US
Practice Address - Phone:513-445-9959
Practice Address - Fax:513-725-1276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1100183-SUPV261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0345155Medicaid