Provider Demographics
NPI:1265177422
Name:A CONSCIOUS JOURNEY LLC
Entity type:Organization
Organization Name:A CONSCIOUS JOURNEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:COLLEY
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:616-984-0899
Mailing Address - Street 1:330 HOLMDENE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3730
Mailing Address - Country:US
Mailing Address - Phone:248-935-5135
Mailing Address - Fax:
Practice Address - Street 1:800 MONROE AVE NW STE 201
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1448
Practice Address - Country:US
Practice Address - Phone:616-984-0899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty