Destination Life LLC-S

Primary specialty

Child & Adolescent Psychiatric/Mental Health Clinical Nurse SpecialistTaxonomy code 364SP0807X

Legal business name

DESTINATION LIFE LLC-S

Doing business as

SaJourney

Practice address

7 Jonathan Way
Ellisville, MS 39437-5195

Phone

(817) 473-1312

Fax

(866) 990-2813

NPI assigned

Sep 25, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Zemelda D. CarrNPI 1790003531

Title

Adm

Phone

(817) 473-1312

Specialties & licenses 15

Addresses

Other identifiers 3

Other names 1

• SaJourney Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Zemelda D. Carr, OTR/L, MOT, CST

  • Physical Rehabilitation Occupational Therapist
  • Arlington, TX
  • NPI 1790003531
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627603200000",
    "number": "1023625894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 SE GREEN OAK BLVD STE 130",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760180952",
            "telephone_number": "817-473-1312",
            "fax_number": "866-990-2813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 JONATHAN WAY",
            "city": "ELLISVILLE",
            "state": "MS",
            "postal_code": "394375195",
            "telephone_number": "817-473-1312",
            "fax_number": "866-990-2813"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1759 Broad Park Cir S Ste 113",
            "address_purpose": "LOCATION",
            "city": "Mansfield",
            "state": "TX",
            "postal_code": "760637836",
            "country_code": "US",
            "telephone_number": "817-473-1312",
            "fax_number": "866-990-2813",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DESTINATION LIFE LLC-S",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-25",
        "last_updated": "2021-07-30",
        "certification_date": "2021-07-30",
        "status": "A",
        "authorized_official_last_name": "CARR",
        "authorized_official_first_name": "ZEMELDA",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "ADM",
        "authorized_official_telephone_number": "817-473-1312"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WP0807X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Women's Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364SP0807X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "364SP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03320311",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "25D2200016",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP",
            "identifier": "1C5803",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SaJourney",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist in Ellisville, MS
• Providers in Ellisville, MS by specialty
• Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.