OrganizationActive
Destination Life Llc-S
NPI 1023625894 · Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist · Ellisville, MS
Provider details
- NPI number
- 1023625894
- Entity type
- Organization
- Primary specialty
- Child & Adolescent Psychiatric/Mental Health Clinical Nurse SpecialistPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Zemelda Carr, Adm(817) 473-1312
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
- Clinical Social Worker1041C0700X
Behavioral Health & Social Service Providers
Nursing Service Providers
- Occupational Therapist225X00000X
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
- Mental Health Occupational Therapist225XM0800X
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
- Primary Care Clinic/Center261QP2300X
Ambulatory Health Care Facilities
Practice location
7 Jonathan Way
Ellisville, MS 39437-5195
Phone: (817) 473-1312
Fax: (866) 990-2813
Approximate (ZIP-level) locationGet directions
Mailing address
2001 Se Green Oak Blvd Ste 130
Arlington, TX 76018-0952
Other names (DBA / former)
- Doing business as
- Sajourney
Additional practice locations (1)
- 1759 Broad Park Cir S Ste 113Mansfield, TX 76063-7836Phone: (817) 473-1312Fax: (866) 990-2813
Registry dates
- Enumerated
- 2020-09-25
- Last updated
- 2021-07-30
- Certified
- 2021-07-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.