Healthcare Provider Details

I. General information

NPI: 1942084561
Provider Name (Legal Business Name): MULTIPLE PATHWAYS TO RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3039 N POST RD
INDIANAPOLIS IN
46226-6543
US

IV. Provider business mailing address

634 COBBLESTONE RD
AVON IN
46123-8749
US

V. Phone/Fax

Practice location:
  • Phone: 317-939-3393
  • Fax:
Mailing address:
  • Phone: 317-939-3393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. MINKAH BECKTEMBA
Title or Position: OWNER
Credential:
Phone: 317-939-3393