Healthcare Provider Details

I. General information

NPI: 1023944204
Provider Name (Legal Business Name): SHAPING PATHWAYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21801 CACTUS AVE STE A
MARCH ARB CA
92518-3020
US

IV. Provider business mailing address

1425 CHERRY AVE SPC 154
BEAUMONT CA
92223-1786
US

V. Phone/Fax

Practice location:
  • Phone: 833-526-2333
  • Fax:
Mailing address:
  • Phone: 951-323-7610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: KITTIARA SMOKE SCOTT
Title or Position: DIRECT SERVICE PROVIDER
Credential:
Phone: 951-323-7610