Provider Demographics
NPI:1801337449
Name:JOURNEY COUNSELING AND COMMUNITY SERVICES, LLC
Entity type:Organization
Organization Name:JOURNEY COUNSELING AND COMMUNITY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERWANNA
Authorized Official - Middle Name:COLLIER
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:985-467-0730
Mailing Address - Street 1:PO BOX 1272
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-1272
Mailing Address - Country:US
Mailing Address - Phone:985-467-0730
Mailing Address - Fax:985-467-0674
Practice Address - Street 1:1180 HIGHWAY 51 STE A
Practice Address - Street 2:
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-6365
Practice Address - Country:US
Practice Address - Phone:985-467-0730
Practice Address - Fax:955-467-0674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X, 251S00000X
LA112981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LABH0012803Medicaid