Healthcare Provider Details

I. General information

NPI: 1952789281
Provider Name (Legal Business Name): PATHWAYS NORTHWEST COUNSELING SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2364 MAIN ST SUITE A
PHILOMATH OR
97370-9488
US

IV. Provider business mailing address

611 SISKIYOU BLVD SUITE 8
ASHLAND OR
97520-2151
US

V. Phone/Fax

Practice location:
  • Phone: 541-944-1247
  • Fax:
Mailing address:
  • Phone: 541-944-1247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) 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: MANNY CRUZ
Title or Position: OWNER
Credential:
Phone: 541-944-1247