Healthcare Provider Details

I. General information

NPI: 1902724164
Provider Name (Legal Business Name): PATHWAY TO PEACE COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 TOMPKINS ST APT 2
SYRACUSE NY
13204-1858
US

IV. Provider business mailing address

612 TOMPKINS ST APT 2
SYRACUSE NY
13204-1858
US

V. Phone/Fax

Practice location:
  • Phone: 631-504-8423
  • Fax:
Mailing address:
  • Phone: 631-504-8423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TRACEY A COX
Title or Position: MANAGING MEMBER
Credential: LMHC
Phone: 631-504-8423