Healthcare Provider Details

I. General information

NPI: 1487793840
Provider Name (Legal Business Name): PATHWAYS FAMILY THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S WILKE RD SUITE 234
ARLINGTON HEIGHTS IL
60005-1533
US

IV. Provider business mailing address

1431 HUNTER CIR
NAPERVILLE IL
60540-8383
US

V. Phone/Fax

Practice location:
  • Phone: 630-415-2088
  • Fax:
Mailing address:
  • Phone: 630-415-2088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180007406
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149009842
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166000558
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166000560
License Number StateIL

VIII. Authorized Official

Name: SHILPA B JOBALIA
Title or Position: PRESIDENT
Credential: M.S.
Phone: 630-415-2088