Healthcare Provider Details

I. General information

NPI: 1881064756
Provider Name (Legal Business Name): PATHWAYS TO HEALING COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2015
Last Update Date: 10/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CHEROKEE LN
NOBLESVILLE IN
46062-9073
US

IV. Provider business mailing address

1212 WESTFIELD RD
NOBLESVILLE IN
46062-9278
US

V. Phone/Fax

Practice location:
  • Phone: 317-316-3077
  • Fax:
Mailing address:
  • Phone: 317-316-3077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35001794A
License Number StateIN

VIII. Authorized Official

Name: MRS. KRISTEN DALE BOICE
Title or Position: OWNER/COUNSELOR
Credential: MA, LMFT
Phone: 317-316-3077