Journeys: a Pathway /to Healing, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

JOURNEYS: A PATHWAY /TO HEALING, LLC

Practice address

1250 Moore Lake Dr E Ste 205D
Fridley, MN 55432-5176

Phone

(612) 412-4819

Fax

(651) 304-6027

NPI assigned

May 29, 2019

Organization subpart

No

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

Authorized official

Name

Ms. D'Undra Rynise Willis, MSW, LICSWNPI 1043747926

Title

Mental Health Professional

Phone

(612) 412-4819

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• D'Undra Willis, LICSW

  • Clinical Social Worker
  • Fridley, MN
  • NPI 1043747926
  NPD Authorized official
• Kayeann Margaret Mason, LICSW

  • Clinical Social Worker
  • St. Paul, MN
  • NPI 1225068703
  NPD (past)

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

{
    "created_epoch": "1559088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732233600000",
    "number": "1386202091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 MOORE LAKE DR E STE 205D",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554325176",
            "telephone_number": "612-412-4819",
            "fax_number": "651-304-6027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 MOORE LAKE DR E STE 205D",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554325176",
            "telephone_number": "612-412-4819",
            "fax_number": "651-304-6027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOURNEYS: A PATHWAY /TO HEALING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-29",
        "last_updated": "2024-11-22",
        "certification_date": "2024-11-22",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "D'UNDRA",
        "authorized_official_middle_name": "RYNISE",
        "authorized_official_title_or_position": "MENTAL HEALTH PROFESSIONAL",
        "authorized_official_telephone_number": "612-412-4819",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSW, LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katrina Johnson
• Matthew Michael Johnson, DO
• Megan Johnson, MA, LPCC
• Samantha Julianne Johnson, NP
• William S Johnson
• Joycene M Walstrom and Associates Inc
• Juihsien Kao, PHD, LP PLLC
• Laura Violet July, MD
• Forest William Juvland
• Jana Lynn Kaess, MPT

• Clinical Social Worker in Fridley, MN
• Providers in Fridley, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2024; 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.