Organization
JOURNEY THROUGH LIFE COUNSELING SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BONITA LYNNE WALDNER LCSW (OWNER/LICENSED THERAPIST)
(573) 885-1600
Entity
Organization
Contact information
Practice address
412 N FRANKLIN ST, CUBA, MO 65453-1719
(573) 885-1600
(573) 885-1600
Mailing address
404 MAGNOLIA ST, CUBA, MO 65453-1924
(573) 885-1600
(573) 885-1600
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
103K00000X
Behavior Analyst
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000080817
MEDICARE - EAST
MO
01
—
1831169408
NPI
MO
01
—
1999140933
MISSOURI LCSW
—
05
—
49488311
—
MO
Enumeration date
12/13/2010
Last updated
12/13/2010
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