Healthcare Provider Details

I. General information

NPI: 1124371208
Provider Name (Legal Business Name): PATHWAYS BEHAVIORAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 FRANKLIN ST
WATERLOO IA
50703-4407
US

IV. Provider business mailing address

3362 UNIVERSITY AVE
WATERLOO IA
50701-2006
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-4300
  • Fax:
Mailing address:
  • Phone: 319-235-6571
  • Fax: 319-235-6028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateIA

VIII. Authorized Official

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