Provider Demographics
NPI:1144928615
Name:JOURNEY TO GROW LLC
Entity type:Organization
Organization Name:JOURNEY TO GROW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MHP
Authorized Official - Prefix:
Authorized Official - First Name:ANITRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:870-949-8754
Mailing Address - Street 1:2603 CHAFFIN LN
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-4327
Mailing Address - Country:US
Mailing Address - Phone:318-596-9159
Mailing Address - Fax:
Practice Address - Street 1:2603 CHAFFIN LN
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-4327
Practice Address - Country:US
Practice Address - Phone:318-596-9159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty