Healthcare Provider Details

I. General information

NPI: 1245010081
Provider Name (Legal Business Name): PURPOSEFUL PATHWAYS COUNSELING AND WELLNESS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4247 S PRAIRIE AVE APT 3N
CHICAGO IL
60653-3283
US

IV. Provider business mailing address

4247 S PRAIRIE AVE APT 3N
CHICAGO IL
60653-3283
US

V. Phone/Fax

Practice location:
  • Phone: 630-903-4789
  • Fax:
Mailing address:
  • Phone: 630-903-4789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MALISHA L WEBBER
Title or Position: CEO/CLINICIAN
Credential: LCPC
Phone: 630-903-4789