Healthcare Provider Details

I. General information

NPI: 1447582390
Provider Name (Legal Business Name): PATHWAYS BEHAVIORAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 S WASHINGTON AVE
FREDERICKSBURG IA
50630-1003
US

IV. Provider business mailing address

602 S WASHINGTON AVE
FREDERICKSBURG IA
50630-1003
US

V. Phone/Fax

Practice location:
  • Phone: 319-235-6571
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateIA

VIII. Authorized Official

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