Healthcare Provider Details

I. General information

NPI: 1265616544
Provider Name (Legal Business Name): HEALING PATHWAYS MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2007
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 BURROWS AVENUE
WEST SACRAMENTO CA
95691
US

IV. Provider business mailing address

PO BOX 981612
WEST SACRAMENTO CA
95798
US

V. Phone/Fax

Practice location:
  • Phone: 916-376-8416
  • Fax: 916-376-0759
Mailing address:
  • Phone: 916-376-8416
  • Fax: 916-376-0759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number20A5642
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL CLIFFORD COPELAND
Title or Position: CEO/OWNER
Credential: DO
Phone: 916-376-8416