Provider Demographics
NPI:1164247649
Name:JOURNEY TO SELF COUNSELING LLC
Entity type:Organization
Organization Name:JOURNEY TO SELF COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:HANNAH
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, MSE
Authorized Official - Phone:715-250-0032
Mailing Address - Street 1:47 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54929-1564
Mailing Address - Country:US
Mailing Address - Phone:715-250-0032
Mailing Address - Fax:715-460-3250
Practice Address - Street 1:47 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54929-1564
Practice Address - Country:US
Practice Address - Phone:715-250-0032
Practice Address - Fax:715-460-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty