Healthcare Provider Details

I. General information

NPI: 1194336263
Provider Name (Legal Business Name): PATHWAYS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 E LOHMAN AVE STE 119
LAS CRUCES NM
88001-3172
US

IV. Provider business mailing address

2001 E LOHMAN AVE STE 110
LAS CRUCES NM
88001-3197
US

V. Phone/Fax

Practice location:
  • Phone: 575-649-1104
  • Fax:
Mailing address:
  • Phone: 575-649-1104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: KORI LYNN CONNOLE
Title or Position: OWNER
Credential: LMFT
Phone: 575-649-1104