Healthcare Provider Details

I. General information

NPI: 1336447960
Provider Name (Legal Business Name): PATHWAY OF FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W BEARSS AVE SUITE B
TAMPA FL
33613-1228
US

IV. Provider business mailing address

PO BOX 340067
TAMPA FL
33694-0067
US

V. Phone/Fax

Practice location:
  • Phone: 813-748-1386
  • Fax:
Mailing address:
  • Phone: 813-748-1386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KELLY CROWE
Title or Position: LMHC/MANAGING MEMBER
Credential: LMHC
Phone: 813-748-1386