Provider Demographics
NPI:1972140747
Name:INTENTIONAL JOURNEYS COUNSELING AND CONSULTING, LLC
Entity type:Organization
Organization Name:INTENTIONAL JOURNEYS COUNSELING AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-206-3965
Mailing Address - Street 1:1720 MISTLETOE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-5637
Mailing Address - Country:US
Mailing Address - Phone:541-579-7437
Mailing Address - Fax:
Practice Address - Street 1:1849 WILLAMETTE ST STE 6
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4683
Practice Address - Country:US
Practice Address - Phone:541-206-3965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-28
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty