Basic Information
| Provider Information | |||||||||
| NPI: | 1144791617 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOURNEYS COUNSELING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6210 102ND ST | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794248284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8064454190 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6500 QUAKER AVE STE D | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794135138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8066875413 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2018 | ||||||||
| LastUpdateDate: | 12/10/2018 | ||||||||
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| AuthorizedOfficialLastName: | HOSEK | ||||||||
| AuthorizedOfficialFirstName: | KRISTI | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8064454190 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 208139001 | 05 | TX | MEDICAID |