Provider Demographics
NPI:1043849755
Name:JOURNEY WELL THERAPY AND COACHING PLLC
Entity type:Organization
Organization Name:JOURNEY WELL THERAPY AND COACHING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIERKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:563-321-7650
Mailing Address - Street 1:13109 SAND RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:IL
Mailing Address - Zip Code:61252-9853
Mailing Address - Country:US
Mailing Address - Phone:563-321-7650
Mailing Address - Fax:
Practice Address - Street 1:408 11TH AVENUE
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:IL
Practice Address - Zip Code:61252
Practice Address - Country:US
Practice Address - Phone:563-321-7650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-04
Last Update Date:2020-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)