Provider Demographics
NPI:1386408813
Name:JOURNEY MENTAL HEALTH LLC
Entity type:Organization
Organization Name:JOURNEY MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:775-242-6433
Mailing Address - Street 1:401 RYLAND ST STE 200A
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1643
Mailing Address - Country:US
Mailing Address - Phone:775-242-6433
Mailing Address - Fax:
Practice Address - Street 1:3500 LAKESIDE CT
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4829
Practice Address - Country:US
Practice Address - Phone:775-242-6433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty