Provider Demographics
| NPI: | 1205644580 |
|---|---|
| Name: | JOURNEY TO WELLNESS LLC |
| Entity type: | Organization |
| Organization Name: | JOURNEY TO WELLNESS LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | SHAMESE |
| Authorized Official - Middle Name: | LATRICE |
| Authorized Official - Last Name: | WILLIAMS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 702-527-0660 |
| Mailing Address - Street 1: | 920 BRIDGEWATER ST APT C |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LAS VEGAS |
| Mailing Address - State: | NV |
| Mailing Address - Zip Code: | 89110-5758 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 702-527-0660 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 1240 W OWENS AVE STE 1 |
| Practice Address - Street 2: | |
| Practice Address - City: | LAS VEGAS |
| Practice Address - State: | NV |
| Practice Address - Zip Code: | 89106-2452 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 702-527-0660 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | JOURNEY TO WELLNESS LLC |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2024-12-19 |
| Last Update Date: | 2024-12-19 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
