Healthcare Provider Details

I. General information

NPI: 1013251792
Provider Name (Legal Business Name): PATHWAYS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 UNITVERSITY AVE W # 6
ST. PAUL MN
55104
US

IV. Provider business mailing address

1919 UNIVERSITY AVE W # 6
ST. PAUL MN
55104
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number2581
License Number StateMN

VIII. Authorized Official

Name: MRS. LORI BORSCHKE
Title or Position: OWNER
Credential:
Phone: 651-641-1555