Provider Information for 1093221335
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JOURNEY THERAPY AT THE BARN, LLC
Organization Subpart: NO
NPI: 1093221335
Last Updated: 2017-12-22
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1093221335 | ||||||||
| Enumeration Date | 2017-12-22 | ||||||||
| NPI Type | NPI-2 Organization | ||||||||
| Status | Active | ||||||||
| Authorized Official Information | Name: AMY M ROTH MS, LPCMH, NCC Title: Owner/Therapist Phone: 6058388545 | ||||||||
| Mailing Address | 1500 S SYCAMORE AVE STE 200 SIOUX FALLS, SD 57110-3711 United States Phone: 605-838-8545 | Fax:605-271-4155 | ||||||||
| Primary Practice Address | 1500 S SYCAMORE AVE STE 200 SIOUX FALLS, SD 57110-3711 United States Phone: 605-838-8545 | Fax:605-271-4155 | ||||||||
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