Healthcare Provider Details

I. General information

NPI: 1780564070
Provider Name (Legal Business Name): EMPATHIC PATHWAYS BEHAVIORAL AND MENTAL HEALTH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 ALPINE BLVD STE 1
ALPINE CA
91901-2395
US

IV. Provider business mailing address

2535 ALPINE BLVD STE 1
ALPINE CA
91901-2395
US

V. Phone/Fax

Practice location:
  • Phone: 619-722-0686
  • Fax:
Mailing address:
  • Phone: 619-722-0686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MAILA ELISA WILSON
Title or Position: LMFT/ PRESIDENT
Credential: MA
Phone: 619-722-0686