Healthcare Provider Details

I. General information

NPI: 1811318504
Provider Name (Legal Business Name): PATHWAYS FOR LIFE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 SW WOODSIDE DR
TOPEKA KS
66614-5326
US

IV. Provider business mailing address

2950 SW WOODSIDE DR
TOPEKA KS
66614-5326
US

V. Phone/Fax

Practice location:
  • Phone: 785-383-9163
  • Fax: 785-748-4800
Mailing address:
  • Phone: 785-383-9163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number3075
License Number StateKS

VIII. Authorized Official

Name: MRS. RHONDA LEIGH HALVERSON
Title or Position: THERAPIST
Credential: LSCSW
Phone: 785-383-9163