Healthcare Provider Details

I. General information

NPI: 1134939929
Provider Name (Legal Business Name): PATHWAYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9123 SE SAINT HELENS ST STE 275
CLACKAMAS OR
97015-6801
US

IV. Provider business mailing address

PO BOX 2134
LAKE OSWEGO OR
97035-0643
US

V. Phone/Fax

Practice location:
  • Phone: 503-770-0875
  • Fax:
Mailing address:
  • Phone: 503-770-0875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
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: EYDIE DIANE ARAGON
Title or Position: OWNER
Credential: LMFT
Phone: 831-594-5225