MEDICARE: NEW PATH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6401013674	MI

General Provider Information

NPI Number	:	1275053498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW PATH LLC

Provider Business Mailing Address
First Line	:	17214 VAN WAGONER RD
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-9780
Country	:	US
Telephone Number	:	231-670-0663
Fax Number	:

Provider Business Practice Location Address
First Line	:	17214 VAN WAGONER RD
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-9780
Country	:	US
Telephone Number	:	231-670-0663
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANA HOOD
Credential	:
Telephone Number	:	231-670-0663

Provider Enumeration Date	:	06/20/2017
Last Update Date	:	01/21/2022

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Directions to “NEW PATH LLC ” Practice Location

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