Provider Demographics
NPI:1902651920
Name:JOURNEY THERAPEUTICS MARRIAGE & FAMILY THERAPY INC
Entity Type:Organization
Organization Name:JOURNEY THERAPEUTICS MARRIAGE & FAMILY THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LLERA
Authorized Official - Suffix:
Authorized Official - Credentials:MS LMFT
Authorized Official - Phone:951-465-5052
Mailing Address - Street 1:2127 E FLORIDA AVE STE 262
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-4765
Mailing Address - Country:US
Mailing Address - Phone:951-465-5052
Mailing Address - Fax:
Practice Address - Street 1:27660 MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-8370
Practice Address - Country:US
Practice Address - Phone:951-465-5052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health