Healthcare Provider Details

I. General information

NPI: 1104287937
Provider Name (Legal Business Name): PATHWAYS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301B HARRISON AVE
MCCOMB MS
39648-2829
US

IV. Provider business mailing address

2184 OLD LIBERTY RD
MCCOMB MS
39648-9123
US

V. Phone/Fax

Practice location:
  • Phone: 601-600-2429
  • Fax: 601-600-2428
Mailing address:
  • Phone: 601-600-2429
  • Fax: 601-600-2429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC4173
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: BENTE HESS JOHNSON
Title or Position: SOLE MEMBER
Credential: LCSW
Phone: 601-600-2429