Healthcare Provider Details

I. General information

NPI: 1336249291
Provider Name (Legal Business Name): PATHWAYS OF ARIZONA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3295 W INA RD SUITE 150 & 200
TUCSON AZ
85741
US

IV. Provider business mailing address

1161 N EL DORADO PL STE 203
TUCSON AZ
85715-4607
US

V. Phone/Fax

Practice location:
  • Phone: 520-744-4376
  • Fax: 520-579-1138
Mailing address:
  • Phone: 520-748-7108
  • Fax: 520-745-0638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberBH-3602
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberOTC6491
License Number StateAZ

VIII. Authorized Official

Name: NANCY POE
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 520-570-1460