Healthcare Provider Details

I. General information

NPI: 1538049374
Provider Name (Legal Business Name): FORWARD PATHWAYS - W CAMELBACK CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 W CAMELBACK RD STE 218
PHOENIX AZ
85015-3464
US

IV. Provider business mailing address

1990 W CAMELBACK RD STE 218
PHOENIX AZ
85015-3464
US

V. Phone/Fax

Practice location:
  • Phone: 623-887-2678
  • Fax:
Mailing address:
  • Phone: 623-887-2678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health 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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID T JOHNSON
Title or Position: PROGRAM ADMINISTRATOR
Credential:
Phone: 623-887-2678