Healthcare Provider Details

I. General information

NPI: 1710126586
Provider Name (Legal Business Name): PATHWAYS BEHAVIORAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N MAIN ST
ALLISON IA
50602-7708
US

IV. Provider business mailing address

315 N MAIN ST
ALLISON IA
50602-7708
US

V. Phone/Fax

Practice location:
  • Phone: 319-267-2629
  • Fax: 319-267-2629
Mailing address:
  • Phone: 319-267-2629
  • Fax: 319-267-2629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number1236
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID ALAN BECKER
Title or Position: BUSINESS MANAGER
Credential: CPA
Phone: 319-235-6571