Healthcare Provider Details

I. General information

NPI: 1902729734
Provider Name (Legal Business Name): PATHWAYS OF CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1659 HIGHWAY 171 STE 3
STONEWALL LA
71078-9408
US

IV. Provider business mailing address

257 LORI DR
STONEWALL LA
71078-9617
US

V. Phone/Fax

Practice location:
  • Phone: 318-390-1200
  • Fax: 318-390-1200
Mailing address:
  • Phone: 318-529-8331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: QUALAN JEFFERSON
Title or Position: MANAGING MEMBER
Credential:
Phone: 318-529-8331