Healthcare Provider Details

I. General information

NPI: 1255119913
Provider Name (Legal Business Name): CLEAR PATH TO WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5266 COMMERCE ST
SAINT FRANCISVILLE LA
70775-4409
US

IV. Provider business mailing address

PO BOX 1252
ZACHARY LA
70791-1252
US

V. Phone/Fax

Practice location:
  • Phone: 225-635-3811
  • Fax:
Mailing address:
  • Phone: 225-395-1037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LATOSHA WILLIAMS
Title or Position: OWNER/PMHNP
Credential: APRN, PMHNP-BC
Phone: 225-395-1037