Provider Demographics
NPI:1265117030
Name:DIVINE PATH RANCH
Entity type:Organization
Organization Name:DIVINE PATH RANCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAECKLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:214-415-5123
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-0155
Mailing Address - Country:US
Mailing Address - Phone:214-415-5123
Mailing Address - Fax:
Practice Address - Street 1:6373 COUNTY ROAD 2520
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-8017
Practice Address - Country:US
Practice Address - Phone:323-639-8463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty