Healthcare Provider Details

I. General information

NPI: 1265977557
Provider Name (Legal Business Name): PATHWAYS HUMAN SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 GOLD AVE SW SUITE 236
ALBUQUERQUE NM
87102-3146
US

IV. Provider business mailing address

1524 S IH 35 SUITE 210
AUSTIN TX
78704-8931
US

V. Phone/Fax

Practice location:
  • Phone: 505-998-0422
  • Fax:
Mailing address:
  • Phone: 512-343-8606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1044
License Number StateNM

VIII. Authorized Official

Name: MR. RICHARD SCOTT WALLACE
Title or Position: STATE DIRECTOR
Credential: LCSW
Phone: 512-343-8606