Healthcare Provider Details

I. General information

NPI: 1851531321
Provider Name (Legal Business Name): PATHWAYS THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 FAIR OAKS BLVD STE G
FAIR OAKS CA
95628-7079
US

IV. Provider business mailing address

9700 FAIR OAKS BLVD STE G
FAIR OAKS CA
95628-7079
US

V. Phone/Fax

Practice location:
  • Phone: 916-979-0964
  • Fax: 916-962-1940
Mailing address:
  • Phone: 916-979-0964
  • Fax: 916-962-1940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19276
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number44220
License Number StateCA

VIII. Authorized Official

Name: MS. SALLY ANNE FITTS
Title or Position: CLINICAL DIRECTOR/OWNER
Credential: LCSW
Phone: 916-979-0964