Provider Demographics
NPI:1427351402
Name:JOURNEY THROUGH LIFE COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:JOURNEY THROUGH LIFE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BONITA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:WALDNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:573-885-1600
Mailing Address - Street 1:404 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:MO
Mailing Address - Zip Code:65453-1924
Mailing Address - Country:US
Mailing Address - Phone:573-885-1600
Mailing Address - Fax:573-885-1600
Practice Address - Street 1:412 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:MO
Practice Address - Zip Code:65453-1719
Practice Address - Country:US
Practice Address - Phone:573-885-1600
Practice Address - Fax:573-885-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000080817OtherMEDICARE - EAST
1999140933OtherMISSOURI LCSW
MO1831169408OtherNPI
MO49488311Medicaid