Provider Demographics
NPI:1649636424
Name:NEW JOURNEYS
Entity type:Organization
Organization Name:NEW JOURNEYS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:LACAZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-393-4206
Mailing Address - Street 1:1017 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7023
Mailing Address - Country:US
Mailing Address - Phone:512-393-4206
Mailing Address - Fax:
Practice Address - Street 1:1017 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7023
Practice Address - Country:US
Practice Address - Phone:512-393-4206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid