Healthcare Provider Details

I. General information

NPI: 1073753257
Provider Name (Legal Business Name): PATHWAY PRACTICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HOSPITAL DR
DOVER OH
44622-2058
US

IV. Provider business mailing address

PO BOX 7
DOVER OH
44622-0007
US

V. Phone/Fax

Practice location:
  • Phone: 330-343-6631
  • Fax: 330-343-8188
Mailing address:
  • Phone: 330-343-6631
  • Fax: 330-343-8188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE0001959SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1957
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS0017766
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC0007674
License Number StateOH

VIII. Authorized Official

Name: DR. JOSEPH J GAVIN
Title or Position: CEO
Credential: PH.D.
Phone: 330-343-6631