Provider Demographics
NPI:1740993450
Name:YOUR JOURNEY THERAPY PLLC
Entity type:Organization
Organization Name:YOUR JOURNEY THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLER-PESCHKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:779-444-3446
Mailing Address - Street 1:12N906 MEADOWLARK DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-8919
Mailing Address - Country:US
Mailing Address - Phone:779-444-3446
Mailing Address - Fax:
Practice Address - Street 1:895 S STATE ST UNIT B
Practice Address - Street 2:
Practice Address - City:HAMPSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60140-9600
Practice Address - Country:US
Practice Address - Phone:779-444-3446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty