Healthcare Provider Details

I. General information

NPI: 1457680357
Provider Name (Legal Business Name): PATHWAYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2009
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W SPRING ST
MARQUETTE MI
49855-4630
US

IV. Provider business mailing address

200 W SPRING ST
MARQUETTE MI
49855-4630
US

V. Phone/Fax

Practice location:
  • Phone: 906-233-1236
  • Fax: 906-233-1235
Mailing address:
  • Phone: 906-233-1236
  • Fax: 906-233-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA NELSON
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 906-233-1236