Healthcare Provider Details

I. General information

NPI: 1770410136
Provider Name (Legal Business Name): HEALING PATHWAYS FAMILY THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 S MILLER ST STE S
SANTA MARIA CA
93454-6962
US

IV. Provider business mailing address

PO BOX 1219
SANTA MARIA CA
93456-1219
US

V. Phone/Fax

Practice location:
  • Phone: 805-720-2809
  • Fax:
Mailing address:
  • Phone: 805-720-2809
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANDRA PROVENCIO
Title or Position: OWNER
Credential: LMFT
Phone: 805-720-2809