Healthcare Provider Details

I. General information

NPI: 1194585836
Provider Name (Legal Business Name): PATHWAYS TO WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4228 NEW VISTAS CT NW
ALBUQUERQUE NM
87114-0706
US

IV. Provider business mailing address

4228 NEW VISTAS CT NW
ALBUQUERQUE NM
87114-0706
US

V. Phone/Fax

Practice location:
  • Phone: 505-400-1442
  • Fax:
Mailing address:
  • Phone: 505-400-1442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LEA JEAN HARRISON
Title or Position: MANAGING MEMBER/EXECUTIVE DIRECTOR
Credential:
Phone: 505-400-1442