Provider Demographics
NPI:1104513621
Name:YOUR JOURNEY COUNSELING, PLLC
Entity type:Organization
Organization Name:YOUR JOURNEY COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PROF. COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:PELTZER
Authorized Official - Suffix:II
Authorized Official - Credentials:MA
Authorized Official - Phone:708-638-0027
Mailing Address - Street 1:10062 W 190TH PL STE 109
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8757
Mailing Address - Country:US
Mailing Address - Phone:708-638-0027
Mailing Address - Fax:
Practice Address - Street 1:10062 W 190TH PL STE 109
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8757
Practice Address - Country:US
Practice Address - Phone:708-638-0027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)