Healthcare Provider Details

I. General information

NPI: 1447975842
Provider Name (Legal Business Name): HEALING PATHS THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2022
Last Update Date: 10/07/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 HEATHERGLEN LN
SAN DIMAS CA
91773-1001
US

IV. Provider business mailing address

981 W ARROW HWY # 4418
SAN DIMAS CA
91773-2410
US

V. Phone/Fax

Practice location:
  • Phone: 81-861-8281
  • Fax:
Mailing address:
  • Phone: 626-923-8083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KEMI ARLENE ALEMOH
Title or Position: THERAPIST
Credential: LCSW
Phone: 626-923-8083