Healthcare Provider Details

I. General information

NPI: 1831066240
Provider Name (Legal Business Name): PATHWAY RECOVERY SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 11/02/2025
Certification Date: 11/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W 2ND ST # 109
TAHLEQUAH OK
74464-4723
US

IV. Provider business mailing address

25679 E 795 RD
WELLING OK
74471-2346
US

V. Phone/Fax

Practice location:
  • Phone: 539-476-9090
  • Fax: 539-238-1741
Mailing address:
  • Phone: 539-476-9090
  • Fax: 539-238-1741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JESSE L PRICE
Title or Position: CLINICAL DIRECTOR
Credential: LCSW
Phone: 539-234-9787