Healthcare Provider Details

I. General information

NPI: 1346186194
Provider Name (Legal Business Name): PATHWISE BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 E MAIN ST STE 106
COTTAGE GROVE OR
97424-2039
US

IV. Provider business mailing address

609 E MAIN ST STE 106
COTTAGE GROVE OR
97424-2039
US

V. Phone/Fax

Practice location:
  • Phone: 402-984-3004
  • Fax:
Mailing address:
  • Phone: 541-315-5420
  • Fax: 804-395-6043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA NESIBA
Title or Position: OWNER
Credential: LCSW
Phone: 541-315-5420