Healthcare Provider Details

I. General information

NPI: 1831220748
Provider Name (Legal Business Name): PATHWAYS COUNSELING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 UNIVERSITY AVE W SUITE 6
SAINT PAUL MN
55104-3453
US

IV. Provider business mailing address

1919 UNIVERSITY AVE W SUITE 6
SAINT PAUL MN
55104-3453
US

V. Phone/Fax

Practice location:
  • Phone: 651-641-1555
  • Fax: 651-641-0340
Mailing address:
  • Phone: 651-641-1555
  • Fax: 651-641-0340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberLP1132
License Number StateMN

VIII. Authorized Official

Name: MS. LORI JEAN BORSCHKE
Title or Position: OWNER - PROGRAM DIRECTOR
Credential:
Phone: 651-641-1555