Healthcare Provider Details

I. General information

NPI: 1730098005
Provider Name (Legal Business Name): PURPOSE & PATHWAYS SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 PROSPECT CT
NAPERVILLE IL
60540-0369
US

IV. Provider business mailing address

906 PROSPECT CT
NAPERVILLE IL
60540-0369
US

V. Phone/Fax

Practice location:
  • Phone: 708-683-9613
  • Fax:
Mailing address:
  • Phone: 708-683-9613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MYISHA BOULWARE
Title or Position: OWNER
Credential: PHD
Phone: 708-743-4086