Healthcare Provider Details

I. General information

NPI: 1073457131
Provider Name (Legal Business Name): PATHWAYS TO RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14040 N CAVE CREEK RD STE 205
PHOENIX AZ
85022-6179
US

IV. Provider business mailing address

14040 N CAVE CREEK RD STE 205
PHOENIX AZ
85022-6179
US

V. Phone/Fax

Practice location:
  • Phone: 602-394-9516
  • Fax:
Mailing address:
  • Phone: 602-394-9516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: FATMATA TARAWALLY
Title or Position: CEO
Credential:
Phone: 602-394-9516