Provider Demographics
NPI:1457903122
Name:INTENTIONAL JOURNEY COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:INTENTIONAL JOURNEY COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:JAYNE
Authorized Official - Last Name:KAREL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LMSW, CAADC
Authorized Official - Phone:269-588-1441
Mailing Address - Street 1:5084 LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-1557
Mailing Address - Country:US
Mailing Address - Phone:269-588-1441
Mailing Address - Fax:269-775-7551
Practice Address - Street 1:5084 LOVERS LN
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-1557
Practice Address - Country:US
Practice Address - Phone:269-588-1441
Practice Address - Fax:269-775-7551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-12
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty