Provider Demographics
NPI:1285111278
Name:HEALING YOUR JOURNEY THERAPY, LLC
Entity type:Organization
Organization Name:HEALING YOUR JOURNEY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:DELCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:574-850-4267
Mailing Address - Street 1:222 DONMOYER AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-1864
Mailing Address - Country:US
Mailing Address - Phone:574-319-1653
Mailing Address - Fax:574-406-7966
Practice Address - Street 1:509 W MCKINLEY AVE STE 3
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-5564
Practice Address - Country:US
Practice Address - Phone:574-319-1653
Practice Address - Fax:574-406-7966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007827A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty