| Journey 4 Self Llc | |
|
121 E North St Sidney OH 45365-2709 | |
| (973) 902-2183 | |
| (937) 963-0932 |
| Full Name | Journey 4 Self Llc |
|---|---|
| Speciality | Social Worker |
| Location | 121 E North St, Sidney, Ohio |
| Authorized Official Name and Position | Mary Jean Carpenter (OWNER) |
| Authorized Official Contact | 9379022183 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Journey 4 Self Llc 2338 Aldrin Dr Sidney OH 45365-1510 Ph: (937) 902-2183 | Journey 4 Self Llc 121 E North St Sidney OH 45365-2709 Ph: (973) 902-2183 |
| NPI Number | 1720560907 |
|---|---|
| Provider Enumeration Date | 09/04/2018 |
| Last Update Date | 03/15/2024 |
| Certification Date | 03/15/2024 |
| Medicare PECOS PAC ID | 9335574847 |
|---|---|
| Medicare Enrollment ID | O20200110000290 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720560907 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Mary Jean Carpenter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750881660 PECOS PAC ID: 2466886536 Enrollment ID: I20200114002265 |
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