Healthcare Provider Details

I. General information

NPI: 1750105896
Provider Name (Legal Business Name): PATHWAY TO FREEDOM COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 INDIAN RIVER BLVD STE 400-R
VERO BEACH FL
32960-4299
US

IV. Provider business mailing address

3035 11TH TER
VERO BEACH FL
32960-6936
US

V. Phone/Fax

Practice location:
  • Phone: 772-559-0182
  • Fax: 772-365-2716
Mailing address:
  • Phone: 772-559-0182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AZAT KAREN JONES
Title or Position: OWNER
Credential:
Phone: 772-559-0182