Healthcare Provider Details

I. General information

NPI: 1508524844
Provider Name (Legal Business Name): PATHWAYS TO WELLNESS, A PSYCHOTHERAPY PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 CADILLAC AVE # O-109
COSTA MESA CA
92626-1429
US

IV. Provider business mailing address

3505 CADILLAC AVE # O-109
COSTA MESA CA
92626-1429
US

V. Phone/Fax

Practice location:
  • Phone: 714-432-9856
  • Fax: 714-432-7075
Mailing address:
  • Phone: 714-432-9856
  • Fax: 714-432-7075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NANCY D YOUNG
Title or Position: OWNER/CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 714-432-9856